Provider Demographics
NPI:1326316951
Name:LOGAN, PATRICK VINCENT (CPO)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:VINCENT
Last Name:LOGAN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 INDIAN ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1926
Mailing Address - Country:US
Mailing Address - Phone:610-338-0878
Mailing Address - Fax:
Practice Address - Street 1:426 INDIAN ROCK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1926
Practice Address - Country:US
Practice Address - Phone:610-338-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist