Healthcare Provider Details

I. General information

NPI: 1629849229
Provider Name (Legal Business Name): LOGAN DEMPSEY ROBINSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5813 E SAGINAW HWY
GRAND LEDGE MI
48837-9110
US

IV. Provider business mailing address

5813 E SAGINAW HWY
GRAND LEDGE MI
48837-9110
US

V. Phone/Fax

Practice location:
  • Phone: 517-261-9014
  • Fax: 517-999-3472
Mailing address:
  • Phone: 517-261-9014
  • Fax: 517-999-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501016868
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: