Individual
LOGAN C SOUTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4141 N S HERRERA WAY, PHOENIX, AZ 85012-1814
(602) 248-1550
Mailing address
400 E EARLL DR UNIT 612, PHOENIX, AZ 85012-0033
(480) 266-1064
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-014540
AZ
Other
Enumeration date
09/14/2022
Last updated
09/14/2022
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