Provider Demographics
NPI:1104267939
Name:GORGULU, LOGAN SEMIH (PT)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:SEMIH
Last Name:GORGULU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:SEMIH
Other - Middle Name:
Other - Last Name:GORGULU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 AMHERST ST
Mailing Address - Street 2:STE 22
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1019
Mailing Address - Country:US
Mailing Address - Phone:603-880-0448
Mailing Address - Fax:
Practice Address - Street 1:522 AMHERST ST
Practice Address - Street 2:STE 22
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1019
Practice Address - Country:US
Practice Address - Phone:603-880-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist