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Individual

TINA M LOGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RPT

Contact information

Practice address
2555 HIGHWAY 78 E, JASPER, AL 35501-3433
(205) 385-7919
(205) 803-6458
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 238-7217

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH 3715
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
63-1196634
EMPLOYER TAX ID
AL
01
71-0945220
EMPLOYER TAX ID
AL
Enumeration date
02/08/2007
Last updated
09/21/2023
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