Provider Demographics
NPI:1427839810
Name:TAYLOR, LOGAN WILLIAM
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:WILLIAM
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 EAST BRADFORD PARKWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6513
Mailing Address - Country:US
Mailing Address - Phone:417-881-2900
Mailing Address - Fax:417-881-2918
Practice Address - Street 1:1630 EAST BRADFORD PARKWAY
Practice Address - Street 2:SUITE E
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6513
Practice Address - Country:US
Practice Address - Phone:417-881-2900
Practice Address - Fax:417-881-2918
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023032902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist