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General NPI Number Information
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NPI Number | 1689364507
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Entity Type | Individual
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Provider Name | LOGAN WEITHMAN
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Gender | Male
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 3773 OLENTANGY RIVER RD STE 201
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City | COLUMBUS
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State | OH
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Zip | 43214-3425
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Country | US
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Telephone | 614-407-8645
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Fax |
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Provider Business Mailing Address
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Address Line | 3195 RYAN MEADOW PL
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City | GALENA
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State | OH
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Zip | 43021-9205
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Country | US
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Telephone | 614-507-0429
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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 | PT020425
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License Number State | OH
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