MEDICARE: DANIELLE CALLAHAN R.M.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2442	CO

General Provider Information

NPI Number	:	1033343959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE CALLAHAN R.M.T

Provider Business Mailing Address
First Line	:	2227 N WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6946
Country	:	US
Telephone Number	:	719-205-9808
Fax Number	:	719-634-4538

Provider Business Practice Location Address
First Line	:	2227 N WEBER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6946
Country	:	US
Telephone Number	:	719-205-9808
Fax Number	:	719-634-4538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/06/2009

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