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General NPI Number Information
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NPI Number | 1891451449
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Entity Type | Individual
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Provider Name | GARRETT LOGAN DPT
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Gender | Male
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 2040 GAUSE BLVD E
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City | SLIDELL
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State | LA
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Zip | 70461-5453
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Country | US
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Telephone | 985-875-2370
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 CANAL BANK DR
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City | SLIDELL
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State | LA
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Zip | 70461-6644
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 10385
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License Number State | LA
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