Provider Demographics
NPI:1306658968
Name:BIRCH, CALLI (DPT)
Entity type:Individual
Prefix:
First Name:CALLI
Middle Name:
Last Name:BIRCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W STUART RD APT 110
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-1237
Mailing Address - Country:US
Mailing Address - Phone:604-818-4263
Mailing Address - Fax:
Practice Address - Street 1:1887 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9426
Practice Address - Country:US
Practice Address - Phone:360-384-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61599269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist