Provider Demographics
NPI:1255149456
Name:BARTEL, LOGAN THOMAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:THOMAS
Last Name:BARTEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 VERNON CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4104
Mailing Address - Country:US
Mailing Address - Phone:469-847-8574
Mailing Address - Fax:
Practice Address - Street 1:4301 W PLANO PKWY # 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5605
Practice Address - Country:US
Practice Address - Phone:972-492-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1401538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist