Lisa Marie Logan, LMT
Individual provider Active NPI Massage Therapist · Melrose, FL
NPI 1548096969 · NPPES record last updated Sep 11, 2024
Key facts
- NPI
- 1548096969
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 76038 (FL)
- Practice address
- 309 State Road 26
Melrose, FL 32666-3906 - Phone
- (352) 225-1275
- NPI assigned
- Sep 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76038 | FL | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 76038 | FL | Yes |
Addresses
Primary practice location
309 State Road 26
Melrose, FL 32666-3906
Mailing address
PO Box 482
Earleton, FL 32631-0482
Phone (352) 225-1275
Other providers in Melrose, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.