Logan, Suzanne E

Logan, Suzanne E is an individual health care provider with primary practice located at 2300 N Edward St , Decatur IL 62526-4163. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Logan, Suzanne E can be contacted via phone (217) 876-2690.

Contact Information

Primary practice address
2300 N Edward St Decatur IL 62526-4163
Phone: (217) 876-2690
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 160002521 Illinois

Profile Details

NPI number 1629333554
LBN Legal business name Logan, Suzanne E
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2012
Last updated Jul 6th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629333554 NPPES
Illinois MEDICAID 160002521

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