Individual provider Active NPI

Logan Nicholas Taylor, DPT

  • Physical Therapist
  • Liberty, MO
National Provider Identifier
1346865110
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2020015509 Issued in MO
Practice address
102 S Forrest Ave
Liberty, MO 64068-1908
Phone
(816) 429-5199
Fax
(816) 429-7129
NPI assigned
Jun 8, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2020015509 MO Primary

Addresses

Primary practice location

102 S Forrest Ave
Liberty, MO 64068-1908

Mailing address

102 S Forrest Ave
Liberty, MO 64068-1908
Phone (816) 429-5199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200929001420 MO Practitioner - Physical Therapist in Private Practice 7012336852 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hill Pro-Motion Physical Therapy, LLCGroup PAC ID 1153582416, 9 clinicians

Practice addresses (Care Compare)

701 NE Lakewood Blvd
Lees Summit, MO 64064-1353
Phone (816) 607-7180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Complete PT, LLC Physical Therapist CurrentSince Jun 17, 2020 Accepting new patients
Hill Pro-Motion Physical Therapy, LLC Physical Therapist CurrentSince Sep 30, 2024 Accepting new patients

Locations

701 NE Lakewood Blvd
Lees Summit, MO 64064
Phone (816) 607-7180

1321 SW Market St
Lees Summit, MO 64081
Phone (816) 607-7180

102 S Forrest Ave
Liberty, MO 64068
Phone (515) 341-2721

1005 N State Route 291
Liberty, MO 64068
Phone (816) 429-5199

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1346865110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S FORREST AVE",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640681908",
            "telephone_number": "816-429-5199",
            "fax_number": "816-429-7129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S FORREST AVE",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640681908",
            "telephone_number": "816-429-5199",
            "fax_number": "816-429-7129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "LOGAN",
        "middle_name": "NICHOLAS",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2020015509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.