Provider Demographics
NPI:1063681997
Name:LOGAN, KRISTINE MARGARET (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARGARET
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COLSTRIP
Mailing Address - State:MT
Mailing Address - Zip Code:59323-1858
Mailing Address - Country:US
Mailing Address - Phone:406-748-3600
Mailing Address - Fax:406-748-3606
Practice Address - Street 1:6230 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLSTRIP
Practice Address - State:MT
Practice Address - Zip Code:59323-1858
Practice Address - Country:US
Practice Address - Phone:406-748-3600
Practice Address - Fax:406-748-3606
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist