Provider Demographics
NPI:1528876208
Name:CALLAHAN, JAKE PATRICK (DPT, PT)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:PATRICK
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3015
Mailing Address - Country:US
Mailing Address - Phone:540-440-1124
Mailing Address - Fax:
Practice Address - Street 1:611 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3008
Practice Address - Country:US
Practice Address - Phone:540-440-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist