Healthcare Provider Details

I. General information

NPI: 1205450822
Provider Name (Legal Business Name): LOGAN D WRIGHT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HUSTON DR STE 3
SHEPHERDSVILLE KY
40165-7250
US

IV. Provider business mailing address

115 HUSTON DR STE 3
SHEPHERDSVILLE KY
40165-7250
US

V. Phone/Fax

Practice location:
  • Phone: 502-921-0272
  • Fax:
Mailing address:
  • Phone: 502-921-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTP2020008
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: