Individual
MISS LARA LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
919 CONESTOGA RD, BUILDING 3, SUITE 114, BRYN MAWR, PA 19010-1352
(610) 527-0178
Mailing address
605 WALNUT LN # A3, PHILADELPHIA, PA 19128-1700
(215) 849-5844
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE006543-L
PA
Other
Enumeration date
08/02/2005
Last updated
07/08/2007
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