Jennie Marie Logan, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2101392 Issued in TX

Practice address

473 County Road SE 3370
Winnsboro, TX 75494-5405

Phone

(903) 588-6384

Fax

(903) 860-2542

NPI assigned

Apr 9, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1428537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428537600000",
    "number": "1235525841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 COUNTY ROAD SE 3370",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754945405",
            "telephone_number": "903-588-6384",
            "fax_number": "903-860-2542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 COUNTY ROAD SE 3370",
            "city": "WINNSBORO",
            "state": "TX",
            "postal_code": "754945405",
            "telephone_number": "903-588-6384",
            "fax_number": "903-860-2542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "JENNIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-09",
        "last_updated": "2015-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2101392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "16249756",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mark Lekas, DO
• Stephen Leone, PT
• Janine Lim, PT
• Dawn Marie Looney
• Cordelia Carrington Lovett
• Brandon Lynn Lowder, PTA
• Timothy Lyons, PT
• Caleb Wayne Mabry, PTA

• Physical Therapy Assistant in Winnsboro, TX
• Providers in Winnsboro, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; 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.