Healthcare Provider Details

I. General information

NPI: 1497672653
Provider Name (Legal Business Name): LOGAN KABANCE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17307 SE 272ND ST STE 142
COVINGTON WA
98042-5330
US

IV. Provider business mailing address

4301 S PINE ST STE 600
TACOMA WA
98409-7209
US

V. Phone/Fax

Practice location:
  • Phone: 253-243-7528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: