Individual
MRS. JENNIE MARIE LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
473 COUNTY ROAD SE 3370, WINNSBORO, TX 75494-5405
(903) 588-6384
(903) 860-2542
Mailing address
473 COUNTY ROAD SE 3370, WINNSBORO, TX 75494-5405
(903) 588-6384
(903) 860-2542
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2101392
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16249756
DRIVERS LICENSE
TX
Enumeration date
04/09/2015
Last updated
04/09/2015
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