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NPI Code Detail

MEDICARE: LOGAN PHILIP BRETNEY PT

MEDICARE: LOGAN PHILIP BRETNEY 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 Therapist3603NV

General Provider Information

NPI Number : 1841716727
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN PHILIP BRETNEY PT
Provider Business Mailing Address
First Line : 5751 E HACIENDA AVE UNIT 152
Second Line :
City : LAS VEGAS
State : NV
Zip : 89122-0234
Country : US
Telephone Number : 310-710-7752
Fax Number :
Provider Business Practice Location Address
First Line : 3820 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-2228
Country : US
Telephone Number : 702-818-5000
Fax Number : 702-818-5001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2017
Last Update Date : 01/20/2021

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Directions to “ LOGAN PHILIP BRETNEY PT” Practice Location

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