Provider Demographics
NPI:1023649035
Name:BATTREALL, LOGAN D
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:D
Last Name:BATTREALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 TWIN PINES DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9300
Mailing Address - Country:US
Mailing Address - Phone:641-990-5721
Mailing Address - Fax:
Practice Address - Street 1:4707 TWIN PINES DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9300
Practice Address - Country:US
Practice Address - Phone:641-990-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer