Individual
LOGAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
3656 PETERS CREEK ROAD EXT SW # B, ROANOKE, VA 24018-1512
(540) 798-1579
Mailing address
3656 PETERS CREEK ROAD EXT SW # B, ROANOKE, VA 24018-1512
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207787
VA
Other
Enumeration date
06/24/2020
Last updated
06/24/2020
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