Provider Demographics
NPI:1144352188
Name:CALLAWAY, MARY K (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1740 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3608
Mailing Address - Country:US
Mailing Address - Phone:714-739-4941
Mailing Address - Fax:714-670-8711
Practice Address - Street 1:7851 WALKER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1747
Practice Address - Country:US
Practice Address - Phone:714-739-4941
Practice Address - Fax:714-670-8711
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 17838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist