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General NPI Number Information
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NPI Number | 1346023645
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Entity Type | Individual
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Provider Name | CASEY NICOLE LOGAN DPT
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Gender | Female
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 6385 CORPORATE DR STE 307
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-5913
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Country | US
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Telephone | 719-219-9795
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Fax |
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Provider Business Mailing Address
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Address Line | 6173 LANTANA LIGHT VW
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City | COLORADO SPRINGS
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State | CO
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Zip | 80922-3456
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Country | US
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Telephone | 813-765-1445
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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 | PTL.0019448
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT40541
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License Number State | FL
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