Individual
LOGAN MICHAEL RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
789 HOLTON DR, LE MARS, IA 51031-3757
(712) 546-1718
Mailing address
646 11TH ST SW UNIT B1, LE MARS, IA 51031-2562
(712) 369-3057
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
112660
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/21/2021
Last updated
06/09/2022
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