MEDICARE: MRS. JANICE ROAKES MCCALLUM PT

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	225100000X	Physical Therapist	2816	NE

General Provider Information

NPI Number	:	1699024513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE ROAKES MCCALLUM PT

Provider Business Mailing Address
First Line	:	BOX 310
Second Line	:
City	:	HAY SPRINGS
State	:	NE
Zip	:	69347
Country	:	US
Telephone Number	:	308-638-4483
Fax Number	:	308-638-7385

Provider Business Practice Location Address
First Line	:	310 LINE DRIVE
Second Line	:
City	:	HAY SPRINGS
State	:	NE
Zip	:	69347
Country	:	US
Telephone Number	:	308-638-4483
Fax Number	:	308-638-7385

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

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	09/06/2012

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