Provider Demographics
NPI:1235136573
Name:CALLAHAN, MATTHEW PAUL (MPT, MTC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PAUL
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 ELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-6276
Mailing Address - Country:US
Mailing Address - Phone:724-652-4334
Mailing Address - Fax:724-652-1491
Practice Address - Street 1:2730 ELLWOOD RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-6276
Practice Address - Country:US
Practice Address - Phone:724-652-4334
Practice Address - Fax:724-652-1491
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008391L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001795375Medicaid
PA001795375Medicaid
PA035430Medicare ID - Type Unspecified