Provider Demographics
NPI:1457875759
Name:PAYNE, LOGAN RENEE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:RENEE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:RENEE
Other - Last Name:BESSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:244 N MINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-1643
Mailing Address - Country:US
Mailing Address - Phone:308-832-1500
Mailing Address - Fax:308-832-1551
Practice Address - Street 1:244 N MINDEN AVE
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NE
Practice Address - Zip Code:68959-1643
Practice Address - Country:US
Practice Address - Phone:308-832-1500
Practice Address - Fax:308-832-1551
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist