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NPI Code Detail

MEDICARE: LOGAN D FAST DPT

MEDICARE: LOGAN D FAST DPT
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 TherapistPT019740OH

General Provider Information

NPI Number : 1801521109
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN D FAST DPT
Provider Business Mailing Address
First Line : 340 POLARIS PKWY
Second Line :
City : WESTERVILLE
State : OH
Zip : 43082-7971
Country : US
Telephone Number : 614-545-7900
Fax Number : 614-545-7901
Provider Business Practice Location Address
First Line : 8080 N HIGH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43235-6477
Country : US
Telephone Number : 614-545-7914
Fax Number : 614-827-8667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2022
Last Update Date : 01/06/2025

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