Provider Demographics
NPI:1114404324
Name:LOGAN, COURTNEY PAIGE (ATC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PAIGE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 RICHLAND AVE APT 369
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3285
Mailing Address - Country:US
Mailing Address - Phone:317-383-7463
Mailing Address - Fax:
Practice Address - Street 1:612 3RD ST
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-2387
Practice Address - Country:US
Practice Address - Phone:740-423-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer