Provider Demographics
NPI:1568292910
Name:CALLAHAN, MARY (PTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BOEPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:365 CLEARLAKE DR W
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-4534
Mailing Address - Country:US
Mailing Address - Phone:405-210-5511
Mailing Address - Fax:
Practice Address - Street 1:777 BELL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2112
Practice Address - Country:US
Practice Address - Phone:615-731-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4526225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant