Provider Demographics
NPI:1942085436
Name:BROOKS, LOGAN (DPT)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:BROOKS
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 1:2122 MARICOURT ST
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-1684
Mailing Address - Country:US
Mailing Address - Phone:615-934-2179
Mailing Address - Fax:
Practice Address - Street 1:636 GRASSMERE PARK
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-9703
Practice Address - Country:US
Practice Address - Phone:615-979-4754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist