Logan Howard Daniel Latvis, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

CP033283A Issued in AZ

Practice address

Corner of Rte 12 and, Rte 7
Fort Defiance, AZ 86504

Phone

(928) 729-8000

NPI assigned

Aug 15, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

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": "1723680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1447082789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2014 RIDGE AVE",
            "city": "MASS CITY",
            "state": "MI",
            "postal_code": "499485107",
            "telephone_number": "906-390-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF RTE 12 AND, RTE 7",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATVIS",
        "first_name": "LOGAN",
        "middle_name": "HOWARD DANIEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-15",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "4159-19",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502008461",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06006862A",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AZ",
            "license": "CP033283A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benedict Stefan Landgren Mills, M.D.
• Joan Lanier, APRN
• Chaz Michael Lasseigne, CRNA
• Judith Elaine Latner, F.N.P.
• Mark A. Latta, O.D.
• Nicholas Dehner Laughton, PHARMD, MPH
• Alan Lazzar
• Nghiem Thanh Le, DDS
• Robin Cuong Le, D.D.S.
• Samantha Gwen Lee, LMSW, LASAC

• Physical Therapy Assistant in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Physical Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.