Healthcare Provider Details

I. General information

NPI: 1982390951
Provider Name (Legal Business Name): LOGAN NICOLE MINTO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16838 E PALISADES BLVD STE B121
FOUNTAIN HILLS AZ
85268-3789
US

IV. Provider business mailing address

14287 N 87TH ST STE 220
SCOTTSDALE AZ
85260-3698
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-2595
  • Fax:
Mailing address:
  • Phone: 480-937-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020255
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33932
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: