Individual
LOGAN HOWARD DANIEL LATVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
CORNER OF RTE 12 AND, RTE 7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
2014 RIDGE AVE, MASS CITY, MI 49948-5107
(906) 390-2185
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06006862A
IN
225200000X
Physical Therapy Assistant
4159-19
WI
225200000X
Physical Therapy Assistant
5502008461
MI
225200000X
Physical Therapy Assistant
Primary
CP033283A
AZ
Other
Enumeration date
08/15/2024
Last updated
08/15/2024
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