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General NPI Number Information
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NPI Number | 1750005856
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Entity Type | Individual
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Provider Name | LOGAN ROONEY LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 700 PELHAM RD N
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City | JACKSONVILLE
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State | AL
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Zip | 36265-1602
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Country | US
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Telephone | 256-782-5526
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Fax |
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Provider Business Mailing Address
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Address Line | 5107 BOGLES RUN RD
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City | URBANA
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State | OH
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Zip | 43078-8413
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2630
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License Number State | AL
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