Organization
ELEMENT PHYSICAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY J LOGAN DO (OWNER)
(816) 924-9475
Entity
Organization
Contact information
Practice address
601 E. 63RD STREET, SUITE 210, KANSAS CITY, MO 64110-3303
(816) 924-9475
Mailing address
PO BOX 16861, RAYTOWN, MO 64133-9998
(816) 924-9475
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2010035953
MO
Other
Enumeration date
06/02/2011
Last updated
05/05/2016
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