Provider Demographics
NPI:1154636108
Name:CALLAHAN, KIMBERLY CHRISTINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CHRISTINE
Last Name:CALLAHAN
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 1:618 ASHLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-6419
Mailing Address - Country:US
Mailing Address - Phone:779-771-4657
Mailing Address - Fax:
Practice Address - Street 1:618 ASHLEIGH LN
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-6419
Practice Address - Country:US
Practice Address - Phone:779-771-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist