Provider Demographics
NPI:1982584132
Name:DOETSCHMAN, LOGAN STEVEN
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:STEVEN
Last Name:DOETSCHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 N MONA LISA RD APT 1306
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4515
Mailing Address - Country:US
Mailing Address - Phone:520-261-8499
Mailing Address - Fax:
Practice Address - Street 1:7300 N MONA LISA RD APT 1306
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4515
Practice Address - Country:US
Practice Address - Phone:520-261-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT29814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist