Individual
LOGAN WALLACE
Active
Individual
LOGAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
110010
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
01
—
568946544
BCBS
—
01
—
5874
HEALTH PARTNERS
—
Enumeration date
12/05/2022
Last updated
02/02/2026
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