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NPI Code Detail

MEDICARE: MICHELLE ANNETTE MCCALLUM P.T.

MEDICARE: MICHELLE ANNETTE MCCALLUM P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT007527LPA
2225100000XPhysical Therapist005034KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144295759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE ANNETTE MCCALLUM P.T.
Provider Business Mailing Address
First Line : 3480 YORKSHIRE MEDICAL PARK
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-1886
Country : US
Telephone Number : 859-263-5140
Fax Number : 859-263-5141
Provider Business Practice Location Address
First Line : 3480 YORKSHIRE MEDICAL PARK
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-1886
Country : US
Telephone Number : 859-263-5140
Fax Number : 859-263-5141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2006
Last Update Date : 07/21/2022

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