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NPI Code Detail

MEDICARE: THERESA LOGAN PTA

MEDICARE:   THERESA  LOGAN  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA3033MD

General Provider Information

NPI Number : 1023447026
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA LOGAN PTA
Provider Business Mailing Address
First Line : 18109 PRINCE PHILIP DR STE 155
Second Line :
City : OLNEY
State : MD
Zip : 20832-1591
Country : US
Telephone Number : 301-260-3280
Fax Number : 301-260-3279
Provider Business Practice Location Address
First Line : 18109 PRINCE PHILIP DR STE 155
Second Line :
City : OLNEY
State : MD
Zip : 20832-1591
Country : US
Telephone Number : 301-260-3280
Fax Number : 301-260-3279
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2013
Last Update Date : 07/31/2020

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Directions to “ THERESA LOGAN PTA” Practice Location

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