Individual
MR. LOGAN BENEDICT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1155 W PARKVIEW ST, BOLIVAR, MO 65613-7801
(417) 777-7763
Mailing address
659 KAYS POINT RD, LAKE OZARK, MO 65049-4779
(573) 723-0521
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2023035475
MO
Other
Enumeration date
09/13/2022
Last updated
11/06/2025
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