Healthcare Provider Details

I. General information

NPI: 1538094339
Provider Name (Legal Business Name): LOGAN S REIGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 CARMICHAEL WAY STE 303
CHESAPEAKE VA
23322-2185
US

IV. Provider business mailing address

PO BOX 392573
PITTSBURGH PA
15251-1661
US

V. Phone/Fax

Practice location:
  • Phone: 757-908-2106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217825
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: