Provider Demographics
NPI:1598345316
Name:CALLAHAN, CATHERINE DENISE (CTRS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DENISE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 BORDER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-5906
Mailing Address - Country:US
Mailing Address - Phone:210-421-1460
Mailing Address - Fax:
Practice Address - Street 1:2484 GARDEN AVE STE 5022
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-7802
Practice Address - Country:US
Practice Address - Phone:210-539-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58180225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist