Individual
LOGAN MICHAEL WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
800 UNIVERSITY DR, NORTHWEST MISSOURI STATE UNIVERSITY, MARYVILLE, MO 64468-6015
(712) 309-8122
Mailing address
810 PARK ST, TABOR, IA 51653-2027
(712) 309-8122
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2016032963
MO
Other
Enumeration date
03/26/2015
Last updated
11/18/2016
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