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General NPI Number Information
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NPI Number | 1700619467
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Entity Type | Individual
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Provider Name | LOGAN ROLLINS DUFFY
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Gender | Male
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 4514 OLD MONROE RD STE B
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5308
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Country | US
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Telephone | 980-890-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 4212 MATTHEWS LN
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City | KENSINGTON
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State | MD
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Zip | 20895-4036
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Country | US
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Telephone | 703-919-1913
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P24726
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License Number State | NC
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