MEDICARE: MR. GEORGE FRANCIS LOGUE PT

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
1	225100000X	Physical Therapist	PT002123L	PA

General Provider Information

NPI Number	:	1295855062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE FRANCIS LOGUE PT

Provider Business Mailing Address
First Line	:	6 HICKORY LN
Second Line	:
City	:	CHALFONT
State	:	PA
Zip	:	18914-2013
Country	:	US
Telephone Number	:	215-822-6442
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 HICKORY LN
Second Line	:
City	:	CHALFONT
State	:	PA
Zip	:	18914-2013
Country	:	US
Telephone Number	:	215-822-6442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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