Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305204636 | VA |
NPI | 1023538444 |
---|---|
Provider Name | Kathryn Marie Logsdon |
First Address | Midlothian, VA 23113-2681 |
Second Address | Midlothian, VA 23113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 27/06/2017 |