Basic Information
| Provider Information | |||||||||
| NPI: | 1104458934 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAFFIN | ||||||||
| FirstName: | LOGAN | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | DPT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7035 WINDSONG LN APT 12 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452414137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136175463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 E BUSINESS WAY STE C | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452412374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133893666 | ||||||||
| FaxNumber: | 5133893665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2020 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P19395 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT019699 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.