Provider Demographics
NPI:1104458934
Name:CHAFFIN, LOGAN EDWARD (DPT, ATC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:EDWARD
Last Name:CHAFFIN
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 WINDSONG LN APT 12
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4137
Mailing Address - Country:US
Mailing Address - Phone:513-617-5463
Mailing Address - Fax:
Practice Address - Street 1:500 E BUSINESS WAY STE C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2374
Practice Address - Country:US
Practice Address - Phone:513-389-3666
Practice Address - Fax:513-389-3665
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19395225100000X
OHPT019699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist