Active NPI
Joelle Logan, PT
- Physical Therapist
- Wylie, TX
National Provider Identifier
1790343432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3123766
- Practice address
- 600 Cooper Dr Ste 130
Wylie, TX 75098-3969 - Phone
- (972) 442-6525
- Fax
- (972) 442-6543
- NPI assigned
- May 29, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3123766 | TX | Primary |
Addresses
Primary practice location
600 Cooper Dr Ste 130
Wylie, TX 75098-3969
Mailing address
1308 Taos LN
Wylie, TX 75098-4868
Phone (972) 768-5612
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3123766 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559088000000",
"number": "1790343432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 TAOS LN",
"city": "WYLIE",
"state": "TX",
"postal_code": "750984868",
"telephone_number": "972-768-5612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 COOPER DR STE 130",
"city": "WYLIE",
"state": "TX",
"postal_code": "750983969",
"telephone_number": "972-442-6525",
"fax_number": "972-442-6543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "JOELLE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-29",
"last_updated": "2019-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "3123766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wylie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.