Provider Demographics
NPI:1831436385
Name:CALLAHAN, AUSTIN (PT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3522
Mailing Address - Country:US
Mailing Address - Phone:951-274-7744
Mailing Address - Fax:951-274-7754
Practice Address - Street 1:3908 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3522
Practice Address - Country:US
Practice Address - Phone:951-274-7744
Practice Address - Fax:951-274-7754
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 39668225100000X
MA22253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist