Provider Demographics
NPI:1093593188
Name:CALLONEA, THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CALLONEA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MALAGA CT
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7001
Mailing Address - Country:US
Mailing Address - Phone:530-499-3977
Mailing Address - Fax:
Practice Address - Street 1:11327 FOLSOM BLVD STE 180
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6208
Practice Address - Country:US
Practice Address - Phone:530-499-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3049122081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine