Provider Demographics
NPI:1245530963
Name:LOGRASSO, JODY A (MSPT)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:A
Last Name:LOGRASSO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4410
Mailing Address - Country:US
Mailing Address - Phone:516-883-8262
Mailing Address - Fax:
Practice Address - Street 1:9 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4410
Practice Address - Country:US
Practice Address - Phone:516-883-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032287-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist