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General NPI Number Information
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NPI Number | 1780464446
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Entity Type | Individual
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Provider Name | LOGAN YOUNGBLOOD PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 405 LAUREL ST
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City | NASHVILLE
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State | GA
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Zip | 31639-3030
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Country | US
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Telephone | 229-543-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 MOORE ST
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City | ADEL
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State | GA
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Zip | 31620-1240
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Country | US
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Telephone | 229-296-1489
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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 | PT012074
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License Number State | GA
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