Provider Demographics
NPI:1457600793
Name:LOGIC NEUROTHERAPY CENTER
Entity Type:Organization
Organization Name:LOGIC NEUROTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:915-843-2454
Mailing Address - Street 1:7618 BOEING DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7618 BOEING DR
Practice Address - Street 2:SUITE F
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1153
Practice Address - Country:US
Practice Address - Phone:915-843-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109107261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation