Individual
LOGAN BROACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7600 AUTUMN PARK WAY, MECHANICSVILLE, VA 23116-3868
(804) 730-0009
Mailing address
9499 ANDREW WICKHAM LN, ASHLAND, VA 23005-7666
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306606622
VA
Other
Enumeration date
09/12/2024
Last updated
09/12/2024
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