Healthcare Provider Details

I. General information

NPI: 1275448284
Provider Name (Legal Business Name): LOGAN LUKES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9614 UNIVERSITY AVE
CEDAR FALLS IA
50613-9115
US

IV. Provider business mailing address

1032 CAPRI DR NE
CEDAR RAPIDS IA
52402-6756
US

V. Phone/Fax

Practice location:
  • Phone: 319-423-1642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: