Provider Demographics
NPI:1295847887
Name:CALHOUN, PATRICK JAMES (PT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3667
Mailing Address - Country:US
Mailing Address - Phone:315-797-9770
Mailing Address - Fax:315-732-7216
Practice Address - Street 1:2114 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3667
Practice Address - Country:US
Practice Address - Phone:315-797-9770
Practice Address - Fax:315-732-7216
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017572-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY337291Medicare ID - Type UnspecifiedMEDICARE