Provider Demographics
NPI:1235549767
Name:CALLAHAN, PATRICK S (LATC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:S
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:LATC
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LATC
Mailing Address - Street 1:3281 115TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-9492
Mailing Address - Country:US
Mailing Address - Phone:701-845-6575
Mailing Address - Fax:701-845-6577
Practice Address - Street 1:570 CHAUTAUQUA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3145
Practice Address - Country:US
Practice Address - Phone:701-845-6575
Practice Address - Fax:701-845-6577
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND128-932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer