Basic Information
| Provider Information | |||||||||
| NPI: | 1952817074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOGSDON | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | TODD | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 613 CRICKLEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193828507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4842660387 | ||||||||
| FaxNumber: | 4842660409 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 SYCAMORE DR | ||||||||
| Address2: | |||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193908818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108696768 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2017 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT014317 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.