Provider Demographics
NPI:1639748999
Name:LOGWOOD, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LOGWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8093
Mailing Address - Country:US
Mailing Address - Phone:757-650-0685
Mailing Address - Fax:
Practice Address - Street 1:5818 HARBOUR VIEW BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3327
Practice Address - Country:US
Practice Address - Phone:757-215-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist