MEDICARE: MRS. SAMANTHA M CALLAHAN DPT

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	070023593	IL

General Provider Information

NPI Number	:	1730652835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA M CALLAHAN DPT

Provider Business Mailing Address
First Line	:	6106 N LEADER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4806
Country	:	US
Telephone Number	:	513-288-1769
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 N LAKEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3112
Country	:	US
Telephone Number	:	773-935-9600
Fax Number	:

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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