Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Logan Stephen Bannon

Individual provider Physical Therapist · NPI 1003494618

Logan Stephen Bannon is a Physical Therapist in Private Practice in Seattle, Washington. Qualified in 2020, 6 years ago. Practices with 520 Physical Therapy, LLC, a 7-clinician group and accepts Medicare assignment.

Years since qualifying
6
In the registry since
2021
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Practice location Address checks out

1107 NE 45th St Ste 100
Seattle, WA 98105-4631
Phone: (206) 545-7844
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X

Record details

NPI number1003494618
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 2, 2021
Last updated in NPPESApril 2, 2021
Certification dateApril 2, 2021
Mailing address790 Remington Blvd, Bolingbrook, IL 60440-4909

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice 520 Physical Therapy, Llc — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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