Provider Demographics
NPI:1407022668
Name:LOGOS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:LOGOS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:828-264-0501
Mailing Address - Street 1:726 STATE FARM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4945
Mailing Address - Country:US
Mailing Address - Phone:828-264-0501
Mailing Address - Fax:828-262-0935
Practice Address - Street 1:726 STATE FARM RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4945
Practice Address - Country:US
Practice Address - Phone:828-264-0501
Practice Address - Fax:828-262-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty