Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT015171 | OH |
NPI | 1003272543 |
---|---|
Provider Name | Dr. Logan Stewart Waddell |
First Address | Cincinnati, OH 45244-3655 |
Second Address | Cincinnati, OH 45255-6138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2016 |
Last Update Date | 13/01/2016 |