Kenneth Geratd Logan, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A-1452 Issued in NV

Practice address

100 Del Mar Gardens Drive
Henderson, NV 89074

Phone

(702) 361-6111

NPI assigned

Apr 19, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1144917345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9850 S. MARYLAND PKWY PMB 358",
            "address_2": "SUITE A5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 DEL MAR GARDENS DRIVE",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89074",
            "telephone_number": "702-361-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "KENNETH",
        "middle_name": "GERATD",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NV",
            "license": "A-1452",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "51576",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Lockhart
• Wesley Chilton Lockhart, DO
• Michelle Loeffler
• Martha Lilia Loera
• Doris Lofton, RBT
• Lily Anne Logan
• Yvonne Loggins
• Saroj Lohani, M.D.
• Rosann Lokers
• Christopher Lolong, PHARMD

• Physical Therapy Assistant in Henderson, NV
• Providers in Henderson, NV by specialty
• Physical Therapy Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.