Provider Demographics
NPI:1871785154
Name:LOGAN, JASON SCOTT (MSPT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:SCOTT
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2705 ARTIE ST SW BLDG 500
Mailing Address - Street 2:SUITE 38
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4761
Mailing Address - Country:US
Mailing Address - Phone:256-489-0270
Mailing Address - Fax:256-489-0272
Practice Address - Street 1:126 MISSOURI AVE
Practice Address - Street 2:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Practice Address - City:FT. LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473
Practice Address - Country:US
Practice Address - Phone:573-596-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171518225100000X
MD20313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist