Provider Demographics
NPI:1467857201
Name:LOGRECO, KRISTEN (PT, DPT, CCS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LOGRECO
Suffix:
Gender:F
Credentials:PT, DPT, CCS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5034 NEW FOREST ST
Mailing Address - Street 2:#8309
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5459
Mailing Address - Country:US
Mailing Address - Phone:210-281-5401
Mailing Address - Fax:210-281-5401
Practice Address - Street 1:5034 NEW FOREST ST
Practice Address - Street 2:#8309
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5459
Practice Address - Country:US
Practice Address - Phone:210-281-5401
Practice Address - Fax:210-281-5401
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1250051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist