Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT-39557 | CA |
NPI | 1063867943 |
---|---|
Provider Name | Michelle Logan |
First Address | Salinas, CA 93906-5382 |
Second Address | Salinas, CA 93906-3514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 28/04/2016 |