Provider Demographics
NPI:1952092082
Name:REDER, LOGAN CHRISTOPHER (DPT)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:CHRISTOPHER
Last Name:REDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 ARNOLD CT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3129
Mailing Address - Country:US
Mailing Address - Phone:989-392-5002
Mailing Address - Fax:
Practice Address - Street 1:424 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4701
Practice Address - Country:US
Practice Address - Phone:989-832-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist