Healthcare Provider Details

I. General information

NPI: 1235136573
Provider Name (Legal Business Name): MATTHEW PAUL CALLAHAN MPT, MTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 ELLWOOD RD
NEW CASTLE PA
16101-6276
US

IV. Provider business mailing address

2730 ELLWOOD RD
NEW CASTLE PA
16101-6276
US

V. Phone/Fax

Practice location:
  • Phone: 724-652-4334
  • Fax: 724-652-1491
Mailing address:
  • Phone: 724-652-4334
  • Fax: 724-652-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008391L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: