Provider Demographics
NPI:1164041984
Name:CURTIS, LOGAN THOMAS (PT)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:THOMAS
Last Name:CURTIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 LOCKHILL SELMA RD APT 638
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1534
Mailing Address - Country:US
Mailing Address - Phone:361-649-6890
Mailing Address - Fax:
Practice Address - Street 1:8811 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5415
Practice Address - Country:US
Practice Address - Phone:361-649-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1306807208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation