Individual
LOGAN BAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1050 SW 3RD AVE, ONTARIO, OR 97914-2193
(541) 881-7330
Mailing address
275 E 7TH ST, WEISER, ID 83672-2303
(208) 549-1008
(208) 549-1396
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT-3687
ID
Other
Enumeration date
08/11/2014
Last updated
05/22/2019
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