Healthcare Provider Details

I. General information

NPI: 1063403178
Provider Name (Legal Business Name): KATE E CALLAHAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 MAIN ST
SPRINGFIELD MA
01107-1111
US

IV. Provider business mailing address

3377 MAIN ST
SPRINGFIELD MA
01107-1111
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-5661
  • Fax:
Mailing address:
  • Phone: 413-734-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number9821
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierY67253
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUESHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: