Logos Outpatient Clinic LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3307 Issued in NC

Legal business name

LOGOS OUTPATIENT CLINIC LLC

Practice address

726 State Farm Rd
Suite B
Boone, NC 28607

Phone

(828) 264-0501

Fax

(828) 262-0935

NPI assigned

Jan 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Danny Eugene Robertson, MSPT

Title

Clinic Director President

Phone

(828) 264-0501

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206576000000",
    "number": "1720068158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 STATE FARM ROAD",
            "address_2": "SUITE B",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "28607",
            "telephone_number": "828-264-0501",
            "fax_number": "828-262-0935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 STATE FARM RD",
            "address_2": "SUITE B",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "28607",
            "telephone_number": "828-264-0501",
            "fax_number": "828-262-0935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGOS OUTPATIENT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-20",
        "last_updated": "2008-03-27",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "DANNY",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR PRESIDENT",
        "authorized_official_telephone_number": "828-264-0501",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "3307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "011W4",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7272080",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "75936",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Lisk, PHARM D
• Listening Booth Therapy PLLC
• Jenny Little
• Giovanni Llibre, MD
• James W Logan, MD
• Logos Physical Therapy, Inc.
• John Robert Lonas, MD
• Rebecca Dianne Long, MC, NCC, LCAS, LCMHC
• Luz Lopez, DMD
• Denise Lovin

• Physical Therapist in Boone, NC
• Providers in Boone, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.