Provider Demographics
NPI:1881284917
Name:HOBBS, LOGAN MATTHEW (DPT)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:MATTHEW
Last Name:HOBBS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MAPLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3134
Mailing Address - Country:US
Mailing Address - Phone:847-926-0106
Mailing Address - Fax:312-694-2020
Practice Address - Street 1:1704 MAPLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3134
Practice Address - Country:US
Practice Address - Phone:847-926-0106
Practice Address - Fax:312-694-2020
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251X0800X
IL070026608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic