Provider Demographics
NPI:1518122654
Name:CALLANAN, MARK ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:CALLANAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 NW MAIN
Mailing Address - Street 2:#100
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081
Mailing Address - Country:US
Mailing Address - Phone:816-524-7040
Mailing Address - Fax:816-524-7057
Practice Address - Street 1:800 NW MAIN
Practice Address - Street 2:#100
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081
Practice Address - Country:US
Practice Address - Phone:816-524-7040
Practice Address - Fax:816-524-7057
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008025212225100000X, 2251G0304X, 2251X0800X, 2251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports