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NPI Code Detail

MEDICARE: LOGAN C OWENS PT

MEDICARE: LOGAN C OWENS 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
1225100000XPhysical Therapist8425TN

General Provider Information

NPI Number : 1588894216
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN C OWENS PT
Provider Business Mailing Address
First Line : 800 CRESCENT CENTRE DR STE 300
Second Line :
City : FRANKLIN
State : TN
Zip : 37067-7285
Country : US
Telephone Number : 615-373-1350
Fax Number : 615-221-9054
Provider Business Practice Location Address
First Line : 8110 CAMP CREEK RD STE 106
Second Line :
City : OLIVE BRANCH
State : MS
Zip : 38654-1622
Country : US
Telephone Number : 662-893-1933
Fax Number : 662-893-1934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2009
Last Update Date : 10/03/2019

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Directions to “ LOGAN C OWENS PT” Practice Location

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