Provider Demographics
NPI:1851488217
Name:LOGMAO, RONNEL (PT)
Entity Type:Individual
Prefix:MR
First Name:RONNEL
Middle Name:
Last Name:LOGMAO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 91ST AVE
Mailing Address - Street 2:APT 2F
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2302
Mailing Address - Country:US
Mailing Address - Phone:718-805-1960
Mailing Address - Fax:
Practice Address - Street 1:328 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4105
Practice Address - Country:US
Practice Address - Phone:718-369-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018334-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist