Provider Demographics
NPI:1932915618
Name:CALLOW, KATHLEEN BLISS (PTA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BLISS
Last Name:CALLOW
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 1:441 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1872
Mailing Address - Country:US
Mailing Address - Phone:856-803-4007
Mailing Address - Fax:
Practice Address - Street 1:45 BROAD ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2201
Practice Address - Country:US
Practice Address - Phone:856-358-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00396700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant