Provider Demographics
NPI:1811751886
Name:RHODES, LOGAN EVERETTE (LMT)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:EVERETTE
Last Name:RHODES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4420
Mailing Address - Country:US
Mailing Address - Phone:210-951-6794
Mailing Address - Fax:210-960-6795
Practice Address - Street 1:10121 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4420
Practice Address - Country:US
Practice Address - Phone:210-951-6794
Practice Address - Fax:210-960-6795
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist