Provider Demographics
NPI:1184370959
Name:APPLEDOORN, LOGAN JUSTIN (PT)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:JUSTIN
Last Name:APPLEDOORN
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 1:1252 BROADWAY STE B
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5827
Mailing Address - Country:US
Mailing Address - Phone:530-622-9410
Mailing Address - Fax:
Practice Address - Street 1:12150 INDUSTRY BLVD STE 42
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9375
Practice Address - Country:US
Practice Address - Phone:209-223-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist