MEDICARE: DR. BLAIR CALLAGHAN PT, DPT

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	2251X0800X	Orthopedic Physical Therapist	PT871981	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT871981	OTHER	DC	LICENSE
2	1750834487	OTHER		NPI

General Provider Information

NPI Number	:	1750834487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR CALLAGHAN PT, DPT

Provider Business Mailing Address
First Line	:	7900 E GREEN LAKE DR N STE 204
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4819
Country	:	US
Telephone Number	:	206-985-2236
Fax Number	:	202-347-2375

Provider Business Practice Location Address
First Line	:	7900 E GREEN LAKE DR N STE 204
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4819
Country	:	US
Telephone Number	:	206-985-2236
Fax Number	:

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

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	12/17/2024

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