Healthcare Provider Details

I. General information

NPI: 1912483207
Provider Name (Legal Business Name): LOGAN SILLIES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 STONE DR STE 500
HARRISON OH
45030-2728
US

IV. Provider business mailing address

3268 ROCKACRES CT
CINCINNATI OH
45239-6113
US

V. Phone/Fax

Practice location:
  • Phone: 513-367-9299
  • Fax:
Mailing address:
  • Phone: 513-245-0100
  • Fax: 513-245-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: