Provider Demographics
NPI:1891455861
Name:LOGAN, JAMES (CTRS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LOGAN
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24442 US HIGHWAY 281 N APT 1026
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7233
Mailing Address - Country:US
Mailing Address - Phone:214-994-6329
Mailing Address - Fax:
Practice Address - Street 1:24442 US HIGHWAY 281 N APT 1026
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7233
Practice Address - Country:US
Practice Address - Phone:214-994-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69312225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty