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1396259867
LOGAN T MAHLOCK
ORLANDO, FL
NPI
1396259867
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: TX AT7560)
Enumeration Date
2017-11-20
Last Update Date
2018-07-04
Business Address
LOGAN T MAHLOCK
4364 SCORPIUS ST
ORLANDO, FL 32816
Phone number: 407-823-2000
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Mailing Address
LOGAN T MAHLOCK
1 TIGER DR
MARSHALL, TX 75670-1412
Phone number:
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