Healthcare Provider Details

I. General information

NPI: 1851271217
Provider Name (Legal Business Name): LOGAN STONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12617 RIDGELINE BLVD
CEDAR PARK TX
78613-1606
US

IV. Provider business mailing address

12617 RIDGELINE BLVD
CEDAR PARK TX
78613-1606
US

V. Phone/Fax

Practice location:
  • Phone: 512-996-0441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1407059
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: