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NPI Code Detail

MEDICARE: MONICA LOGWOOD

MEDICARE:   MONICA  LOGWOOD
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 Therapist2305214396VA

General Provider Information

NPI Number : 1639748999
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA LOGWOOD
Provider Business Mailing Address
First Line : 150 MALLARD DR
Second Line :
City : SUFFOLK
State : VA
Zip : 23434-8093
Country : US
Telephone Number : 757-650-0685
Fax Number :
Provider Business Practice Location Address
First Line : 5818 HARBOUR VIEW BLVD STE 150
Second Line :
City : SUFFOLK
State : VA
Zip : 23435-3327
Country : US
Telephone Number : 757-215-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2021
Last Update Date : 06/22/2021

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Directions to “ MONICA LOGWOOD ” Practice Location

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