Individual
LOGAN THOMAS RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
996 NW CIRCLE BLVD, SUITE 101, CORVALLIS, OR 97330-1485
(541) 757-0878
(541) 757-0879
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06993
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500652534
—
OR
Enumeration date
11/07/2012
Last updated
02/18/2013
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