Provider Demographics
NPI:1467605832
Name:S K CALLAHAN, PHYSICAL THERAPIST, INC.
Entity Type:Organization
Organization Name:S K CALLAHAN, PHYSICAL THERAPIST, INC.
Other - Org Name:SOUTHWEST MEDICAL COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:626-974-5665
Mailing Address - Street 1:1136 VIA VERDE
Mailing Address - Street 2:502
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4401
Mailing Address - Country:US
Mailing Address - Phone:626-974-5665
Mailing Address - Fax:626-974-5665
Practice Address - Street 1:2006 SCARBOROUGH LN
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3740
Practice Address - Country:US
Practice Address - Phone:626-974-5665
Practice Address - Fax:626-974-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25293251E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies