Provider Demographics
NPI:1841596699
Name:LOGGAINS, MARY BETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:LOGGAINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 MALLORY LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2909
Mailing Address - Country:US
Mailing Address - Phone:615-661-5437
Mailing Address - Fax:615-309-8342
Practice Address - Street 1:1647 MALLORY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2909
Practice Address - Country:US
Practice Address - Phone:615-661-5437
Practice Address - Fax:615-309-8342
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist