Individual
MR. BRETT EVAN LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
180 E PULASKI RD, SUITE C, LOWER LEVEL, HUNTINGTON STATION, NY 11746-1915
(631) 396-1595
(631) 396-1597
Mailing address
180 E PULASKI RD, SUITE C, LOWER LEVEL, HUNTINGTON STATION, NY 11746-1915
(631) 396-1595
(631) 396-1597
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
017678-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03167668
—
NY
01
—
P00800649
RAILROAD MEDICARE
NY
Enumeration date
10/10/2006
Last updated
04/27/2021
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