Logan Michael Wood, ATC, LAT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

2016032963 Issued in MO

Practice address

800 University Dr
Northwest Missouri State University
Maryville, MO 64468-6015

Phone

(712) 309-8122

NPI assigned

Mar 26, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1477947547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 PARK ST",
            "city": "TABOR",
            "state": "IA",
            "postal_code": "516532027",
            "telephone_number": "712-309-8122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 UNIVERSITY DR",
            "address_2": "NORTHWEST MISSOURI STATE UNIVERSITY",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644686015",
            "telephone_number": "712-309-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "LOGAN",
        "middle_name": "MICHAEL",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-26",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2016032963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerald W Wilmes, MD
• Hayston W Wilson
• Leslie Alitz Wittmann, OD
• Michael J Wurm, MD
• Erin Elizabeth York, ATC, LAT
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• Student in an Organized Health Care Education/Training Program in Maryville, MO
• Providers in Maryville, MO by specialty
• Student in an Organized Health Care Education/Training Program in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; 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.