Provider Demographics
NPI:1104868645
Name:CALLAWAY, KATHY (PT, MHS, CHT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CALLAWAY
Suffix:
Gender:
Credentials:PT, MHS, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 PRIDES XING STE 112
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-6107
Mailing Address - Country:US
Mailing Address - Phone:302-864-2222
Mailing Address - Fax:
Practice Address - Street 1:750 PRIDES XING STE 112
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6107
Practice Address - Country:US
Practice Address - Phone:302-864-2222
Practice Address - Fax:302-894-1601
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001208E225100000X
DEJ10000374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0033428000OtherAMERIHEALTH
098101OtherPABS
98101OtherPA BS
DE1000038042Medicaid
5070-0013OtherCARE FIRST
76915607OtherNCA
98101OtherPA BS
DE005028F68Medicare ID - Type Unspecified
5070-0013OtherCARE FIRST
098101OtherPABS
PA116966VKFMedicare PIN