Provider Demographics
NPI:1548425887
Name:LOGAN, DORIAN FAYE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:FAYE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DORIAN
Other - Middle Name:FAYE
Other - Last Name:AMEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:2108 W 27TH ST STE K
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3168
Practice Address - Country:US
Practice Address - Phone:785-856-0173
Practice Address - Fax:785-856-0212
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist