Provider Demographics
NPI:1215697420
Name:YAGER, LOGAN COLE (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:COLE
Last Name:YAGER
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 NE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2202
Mailing Address - Country:US
Mailing Address - Phone:308-660-5155
Mailing Address - Fax:
Practice Address - Street 1:309 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5007
Practice Address - Country:US
Practice Address - Phone:308-660-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist