Provider Demographics
NPI:1396551883
Name:CALLAWAY, CHRISTY LYNN (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2628
Mailing Address - Country:US
Mailing Address - Phone:706-226-4642
Mailing Address - Fax:706-226-9785
Practice Address - Street 1:1115 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2628
Practice Address - Country:US
Practice Address - Phone:706-226-4642
Practice Address - Fax:706-226-9785
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000990225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant