Healthcare Provider Details

I. General information

NPI: 1548747587
Provider Name (Legal Business Name): ZACHARY L CALHOON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 THUNDERBIRD ST APT A
LAGO VISTA TX
78645-5888
US

IV. Provider business mailing address

PO BOX 4649
LAGO VISTA TX
78645-0054
US

V. Phone/Fax

Practice location:
  • Phone: 512-267-5400
  • Fax: 512-267-5700
Mailing address:
  • Phone: 512-267-5400
  • Fax: 512-267-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1303973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: