Most Relevant Information
Provider Data
| NPI Number: | 1003494618 |
| Provider Name: | LOGAN STEPHEN BANNON |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/02/2021 |
| Last Updated: | 04/02/2021 |
Provider Practice Location
1107 NE 45TH ST STE 100
SEATTLE
WA
981054631
Practice Location Phone/Fax
| Phone: | 2065457844 |
| Fax: |
Provider Mailing Location
790 REMINGTON BLVD
BOLINGBROOK
IL
604404909
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |