Provider Demographics
NPI:1063958239
Name:RODGERS, LOGAN JOSEPH (PT, DPT)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:JOSEPH
Last Name:RODGERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 SW 88TH CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4125
Mailing Address - Country:US
Mailing Address - Phone:901-517-6558
Mailing Address - Fax:
Practice Address - Street 1:5437 SW 88TH CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4125
Practice Address - Country:US
Practice Address - Phone:901-517-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012741225100000X
TN11640225100000X
FLPT35923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist