# ELEMENT PHYSICAL MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205120649
- **Authorized official:** KELLY J LOGAN DO (OWNER)
- **Authorized official phone:** (816) 924-9475

## Contact information

- **Practice address:** 601 E. 63RD STREET, SUITE 210, KANSAS CITY, MO 64110-3303
- **Practice address phone:** (816) 924-9475
- **Mailing address:** PO BOX 16861, RAYTOWN, MO 64133-9998
- **Mailing address phone:** (816) 924-9475

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 2010035953 | MO | Yes |

## Other

- **Enumeration date:** 06/02/2011
- **Last updated:** 05/05/2016