LOGAN C SOUTHWELL

PHOENIX, AZ
NPI1225750300
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: AZ  PTA-014540)
Enumeration Date2022-09-14
Last Update Date2022-09-14
Business Address
LOGAN C SOUTHWELL PTA
4141 N S HERRERA WAY
PHOENIX, AZ 85012-1814
Phone number: 602-248-1550
Mailing Address
LOGAN C SOUTHWELL PTA
400 E EARLL DR UNIT 612
PHOENIX, AZ 85012-0033
Phone number: 480-266-1064
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