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General NPI Number Information
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NPI Number | 1306431762
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Entity Type | Individual
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Provider Name | LOGAN TYLER CHAMBLEE DPT
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Gender | Male
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Dates
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Enumeration Date | 03/07/2021
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Last Update Date | 03/07/2021
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Provider Practice Location Address
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Address Line | 6700 JEFFERSON ST NE BLDG D2
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4394
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Country | US
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Telephone | 595-232-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 9509 CANDLE LN NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1609
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Country | US
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Telephone | 662-419-4309
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5837
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License Number State | NM
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