Provider Demographics
NPI:1104371608
Name:ARENA, LOGAN ALEXANDER (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:ALEXANDER
Last Name:ARENA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 ATLANTA PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-4327
Mailing Address - Country:US
Mailing Address - Phone:508-868-7179
Mailing Address - Fax:
Practice Address - Street 1:4539 S DALE MABRY HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1404
Practice Address - Country:US
Practice Address - Phone:813-250-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist