Provider Demographics
NPI:1083133052
Name:LOGOYDA, CONNOR MICHAEL
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:MICHAEL
Last Name:LOGOYDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-1039
Mailing Address - Country:US
Mailing Address - Phone:973-294-5802
Mailing Address - Fax:
Practice Address - Street 1:5 FALCON DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-2200
Practice Address - Country:US
Practice Address - Phone:973-294-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2024-11-18
Deactivation Date:2018-03-19
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
PART0078002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer