Healthcare Provider Details

I. General information

NPI: 1831436385
Provider Name (Legal Business Name): AUSTIN CALLAHAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 10TH ST
RIVERSIDE CA
92501-3522
US

IV. Provider business mailing address

3908 10TH ST
RIVERSIDE CA
92501-3522
US

V. Phone/Fax

Practice location:
  • Phone: 951-274-7744
  • Fax: 951-274-7754
Mailing address:
  • Phone: 951-274-7744
  • Fax: 951-274-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 39668
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22253
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: