Provider Demographics
NPI:1275791519
Name:CALLAHAN, DIANA KATHLEEN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:KATHLEEN
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:KATHLEEN
Other - Last Name:GAMACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:660 GOLDEN RIDGE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9541
Mailing Address - Country:US
Mailing Address - Phone:303-274-7321
Mailing Address - Fax:303-233-8755
Practice Address - Street 1:660 GOLDEN RIDGE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:303-274-7321
Practice Address - Fax:303-233-8755
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist