Provider Demographics
NPI:1821629098
Name:LOGAN, ABIGAIL M (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:M
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7403 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4373
Mailing Address - Country:US
Mailing Address - Phone:813-815-9422
Mailing Address - Fax:813-815-9430
Practice Address - Street 1:7403 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4373
Practice Address - Country:US
Practice Address - Phone:813-815-9422
Practice Address - Fax:813-815-9430
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT326762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic