Individual
LOGAN MICHAEL BEN-EZRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS
Contact information
Practice address
14605 POTOMAC BRANCH DR STE 300, WOODBRIDGE, VA 22191-3337
(703) 490-1112
Mailing address
28866 KENDALLWOOD DR, FARMINGTON HILLS, MI 48334-2638
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070.027620
IL
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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