Healthcare Provider Details

I. General information

NPI: 1316428071
Provider Name (Legal Business Name): LOGAN WILLIAM KLAHN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 INVERNESS DR W STE 100
ENGLEWOOD CO
80112-5066
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3333
  • Fax: 303-694-9666
Mailing address:
  • Phone: 970-624-4128
  • Fax: 970-490-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3826
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: