MEDICARE: GARRETT LOGAN 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
1	2251X0800X	Orthopedic Physical Therapist	10385	LA

General Provider Information

NPI Number	:	1891451449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT LOGAN DPT

Provider Business Mailing Address
First Line	:	3801 CANAL BANK DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-6644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 GAUSE BLVD E
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-5453
Country	:	US
Telephone Number	:	985-875-2370
Fax Number	:

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

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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