Provider Demographics
NPI:1811206725
Name:LOGEMAN, MATTHEW TRAVIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TRAVIS
Last Name:LOGEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6013
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-6013
Mailing Address - Country:US
Mailing Address - Phone:630-466-9240
Mailing Address - Fax:630-262-2643
Practice Address - Street 1:38 MAIN STREET
Practice Address - Street 2:SUITES A-B
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5031
Practice Address - Country:US
Practice Address - Phone:630-466-5866
Practice Address - Fax:630-466-5869
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist