MEDICARE: MOLLIE CALLANAN PT

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
1	225100000X	Physical Therapist	3922	AZ

General Provider Information

NPI Number	:	1255369849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE CALLANAN PT

Provider Business Mailing Address
First Line	:	2104 E CATAMARAN DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2822
Country	:	US
Telephone Number	:	602-568-9503
Fax Number	:	480-759-0647

Provider Business Practice Location Address
First Line	:	1355 S HIGLEY RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4799
Country	:	US
Telephone Number	:	480-507-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/17/2018

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Directions to “ MOLLIE CALLANAN PT” Practice Location

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