Provider Demographics
NPI:1639191901
Name:CALLAHAN, SEAN KEVIN (RPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:KEVIN
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2003
Mailing Address - Country:US
Mailing Address - Phone:626-331-0077
Mailing Address - Fax:626-331-0067
Practice Address - Street 1:234 N CITRUS AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2003
Practice Address - Country:US
Practice Address - Phone:626-331-0077
Practice Address - Fax:626-331-0067
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 252932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25293AMedicare ID - Type Unspecified