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General NPI Number Information
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NPI Number | 1427203249
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Entity Type | Organization
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Legal Business Name | LOGICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 555 W GRANADA BLVD STE D9
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City | ORMOND BEACH
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State | FL
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Zip | 32174-9400
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Country | US
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Telephone | 386-673-1880
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Fax |
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Provider Business Mailing Address
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Address Line | 226 N NOVA RD # 384
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5124
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Country | US
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Telephone | 386-673-1880
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHEILA D. NOILES
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Credential | BSN, MT
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Telephone | 386-673-1880
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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 | MA 50432
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License Number State | FL
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