Provider Demographics
NPI:1356548481
Name:LOGAN, EMILY IRENE (PTA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:IRENE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-2512
Mailing Address - Country:US
Mailing Address - Phone:816-262-3079
Mailing Address - Fax:
Practice Address - Street 1:17128 W 198TH ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-8510
Practice Address - Country:US
Practice Address - Phone:816-262-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant