Logan Deroin, DPT
Physical Therapist in Meridian, ID. Individual provider (NPI-1).
NPI number1629624366
StatusActive
Last updated in NPPESAug 16, 2019
Details
- NPI
- 1629624366
- Entity type
- Individual (NPI-1)
- Name
- Logan Deroin
- Credential
- DPT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 16, 2019
- Last updated
- Aug 16, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | – | – | Yes |
Practice location
535 N Locust Grove Rd Ste 170Meridian, ID 83642-9379
Phone 208-917-2660
Mailing address
535 N Locust Grove Rd Ste 170Meridian, ID 83642-9379
Phone 208-917-2660
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