Provider Demographics
NPI:1295170884
Name:LOGSDON, DENISE M (LMT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 BINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3309
Mailing Address - Country:US
Mailing Address - Phone:502-558-9439
Mailing Address - Fax:502-447-4574
Practice Address - Street 1:8906 BINGHAM DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-3309
Practice Address - Country:US
Practice Address - Phone:502-558-9439
Practice Address - Fax:502-447-4574
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist