Provider Demographics
NPI:1174722813
Name:SIMMONS, LOGAN SETH (PT)
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:SETH
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 PHILLIPS 323 RD.
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-9597
Mailing Address - Country:US
Mailing Address - Phone:870-572-2156
Mailing Address - Fax:870-572-2156
Practice Address - Street 1:156 PHILLIPS 323
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-9597
Practice Address - Country:US
Practice Address - Phone:870-572-2156
Practice Address - Fax:870-572-2156
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4195225100000X
ARPT2977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist