Provider Demographics
NPI:1730164815
Name:CALLANEN, MARK LEIPHAM (DPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LEIPHAM
Last Name:CALLANEN
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 1:800 CRESCENT CENTRE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7269
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:4027 HILLSBORO PIKE
Practice Address - Street 2:SUITE 801
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2782
Practice Address - Country:US
Practice Address - Phone:615-385-2201
Practice Address - Fax:615-383-8590
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24601225100000X
TN9745225100000X
KY006776225100000X
IN05012019A225100000X
SC7945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000687Medicaid
TNQ000687Medicaid
CAWPT24601CMedicare PIN