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General NPI Number Information
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NPI Number | 1083133052
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Entity Type | Individual
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Provider Name | CONNOR MICHAEL LOGOYDA
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Gender | Male
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 5 FALCON DR
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City | BROWNSVILLE
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State | PA
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Zip | 15417-2200
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Country | US
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Telephone | 973-294-5802
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Fax |
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Provider Business Mailing Address
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Address Line | 334 CEMETERY RD
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City | PERRYOPOLIS
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State | PA
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Zip | 15473-1039
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Country | US
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Telephone | 973-294-5802
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT007800
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License Number State | PA
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