Individual
LOGAN M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
7707 W DEER VALLEY RD, STE: 100, PEORIA, AZ 85382-2101
(623) 376-9100
(623) 376-9141
Mailing address
4715 N 32ND ST, STE: 108, PHOENIX, AZ 85018-3300
(480) 689-5520
(480) 706-7409
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10255
AZ
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
05/17/2013
Last updated
05/17/2013
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