MEDICARE: CONNOR CALLAHAN

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	070029675	IL

General Provider Information

NPI Number	:	1285598797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR CALLAHAN

Provider Business Mailing Address
First Line	:	1125 N ELMWOOD AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-1314
Country	:	US
Telephone Number	:	872-221-1211
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ CONNOR CALLAHAN ” Practice Location

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