Provider Demographics
NPI:1659407583
Name:LOGUE, ANDREW ASHLEY (MPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ASHLEY
Last Name:LOGUE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:26025 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:248-663-2192
Practice Address - Fax:248-663-1901
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501011344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM08420024Medicare ID - Type Unspecified