Healthcare Provider Details

I. General information

NPI: 1609442250
Provider Name (Legal Business Name): LOGAN DOCKERY PT, DPT, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/27/2021
Certification Date: 06/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 OAK TREE CIR
NORTH LITTLE ROCK AR
72116-7005
US

IV. Provider business mailing address

PO BOX 15538
LITTLE ROCK AR
72231-5538
US

V. Phone/Fax

Practice location:
  • Phone: 501-904-2778
  • Fax: 866-724-7887
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT3908
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT3908
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: