Individual
LOGAN THERESE GROVESTEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1175 BLUE IRIS CT, WISCONSIN RAPIDS, WI 54494-4241
(715) 712-1299
Mailing address
715 DONNA AVE, TOMAH, WI 54660-2228
(608) 387-1585
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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