Provider Demographics
NPI:1033288469
Name:LOGAN, ANDREA ROBINSON (C M T)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ROBINSON
Last Name:LOGAN
Suffix:
Gender:F
Credentials:C M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2325
Mailing Address - Country:US
Mailing Address - Phone:301-559-5428
Mailing Address - Fax:301-559-3004
Practice Address - Street 1:1207 VALLEY DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2325
Practice Address - Country:US
Practice Address - Phone:301-559-5428
Practice Address - Fax:301-559-3004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM01894225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist