=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255341848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI ANNE CALLAHAN MPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 01/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1138 FARMINGTON AVE
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-829-5511
-----------------------------------------------------
Fax | 860-829-5577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 452
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06037-0452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-829-5511
-----------------------------------------------------
Fax | 860-829-5577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 0400003645
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------