Individual
MRS. BRIDGET R LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
115 SPENCER ST, WINSTED, CT 06098-1140
(860) 738-5810
(860) 738-5820
Mailing address
PO BOX 466, CANTON, CT 06019-0466
(606) 936-2268
(860) 693-8002
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0112901
ORTHONET PROVIDER I.D.#
CT
01
—
080005891CT01
ANTHEM PROVIDER I.D.#
CT
Enumeration date
08/30/2006
Last updated
09/15/2020
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