Provider Demographics
NPI:1497713531
Name:CALAWAY, MARK GREGORY (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GREGORY
Last Name:CALAWAY
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 1:600 S MCKINLEY ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5202
Mailing Address - Country:US
Mailing Address - Phone:501-225-0181
Mailing Address - Fax:501-225-0384
Practice Address - Street 1:600 S MCKINLEY ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5202
Practice Address - Country:US
Practice Address - Phone:501-225-0181
Practice Address - Fax:501-225-0384
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT12082251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00753833OtherRRM
ARPT1208OtherASB OF PT
ARP00753833OtherRRM