Healthcare Provider Details

I. General information

NPI: 1558762609
Provider Name (Legal Business Name): MATTHEW RYAN LOGGINS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 N WIMBERLY DR FL 2
FAYETTEVILLE AR
72703-4056
US

IV. Provider business mailing address

3317 N WIMBERLY DR FL 2
FAYETTEVILLE AR
72703-4056
US

V. Phone/Fax

Practice location:
  • Phone: 479-587-3117
  • Fax: 479-587-3185
Mailing address:
  • Phone: 479-587-3117
  • Fax: 479-587-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3922
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: