Provider Demographics
NPI:1477837227
Name:CALLAHAN, TARA ANNE (PTA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANNE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3109
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-3109
Mailing Address - Country:US
Mailing Address - Phone:864-223-1950
Mailing Address - Fax:864-330-3001
Practice Address - Street 1:437 E CAMBRIDGE AVE
Practice Address - Street 2:437 E. CAMBRIDGE AVE.
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2244
Practice Address - Country:US
Practice Address - Phone:864-223-1950
Practice Address - Fax:864-330-3001
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1420225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant