Provider Demographics
NPI:1780895946
Name:BRAD E LOGAN
Entity type:Organization
Organization Name:BRAD E LOGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:512-745-4106
Mailing Address - Street 1:7500 ORRICK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2607
Mailing Address - Country:US
Mailing Address - Phone:512-745-4106
Mailing Address - Fax:512-697-8459
Practice Address - Street 1:7500 ORRICK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-2607
Practice Address - Country:US
Practice Address - Phone:512-745-4106
Practice Address - Fax:512-697-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty