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General NPI Number Information
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NPI Number | 1750686218
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Entity Type | Individual
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Provider Name | SHAUN MICHAEL LOGAN DPT
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Gender | Male
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 08/30/2015
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Provider Practice Location Address
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Address Line | 90 GOODWIN PKWY
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City | SEWELL
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State | NJ
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Zip | 08080-9446
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Country | US
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Telephone | 856-889-6589
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Fax | 856-888-9658
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Provider Business Mailing Address
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Address Line | 90 GOODWIN PKWY
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City | SEWELL
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State | NJ
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Zip | 08080-9446
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Country | US
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Telephone | 856-889-6589
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Fax | 856-889-6589
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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 | 40QA01362900
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License Number State | NJ
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