Most Relevant Information
Provider Data
| NPI Number: | 1003584814 |
| Provider Name: | LOGAN BUCKNER PT, DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/06/2021 |
| Last Updated: | 09/06/2021 |
Provider Practice Location
39000 BOB HOPE DR
RANCHO MIRAGE
CA
922703221
Practice Location Phone/Fax
| Phone: | 7603403911 |
| Fax: |
Provider Mailing Location
109 W ADAMS ST
BENTON
IL
628121826
Provider Mailing Phone/Fax
| Phone: | 6189273668 |
| Fax: |