Individual
LOGAN B. PENDERGRASS
Active
Individual
LOGAN B. PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8854
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1523478
—
TN
01
—
4288724
BLUECROSS BLUESHIELD
TN
01
—
5792655
CIGNA
TN
01
—
P01085928
RAILROAD MEDICARE
—
Enumeration date
02/16/2011
Last updated
04/22/2013
Update your record
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