Individual
LOGAN RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1000
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1240459
TX
225100000X
Physical Therapist
Primary
12509010-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80TT54
BC/BS PROVIDER TRANSACTION NUMBER
TX
Enumeration date
03/05/2014
Last updated
10/11/2024
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