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General NPI Number Information
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NPI Number | 1033288469
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Entity Type | Individual
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Provider Name | ANDREA ROBINSON LOGAN C. M. T.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1207 VALLEY DR
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City | HYATTSVILLE
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State | MD
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Zip | 20782-2325
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Country | US
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Telephone | 301-559-5428
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Fax | 301-559-3004
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Provider Business Mailing Address
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Address Line | 1207 VALLEY DR
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City | HYATTSVILLE
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State | MD
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Zip | 20782-2325
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Country | US
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Telephone | 301-559-5428
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Fax | 301-559-3004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M01894
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License Number State | MD
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