Provider Demographics
NPI:1699024513
Name:MCCALLUM, JANICE ROAKES (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ROAKES
Last Name:MCCALLUM
Suffix:
Gender:F
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:BOX 310
Mailing Address - Street 2:
Mailing Address - City:HAY SPRINGS
Mailing Address - State:NE
Mailing Address - Zip Code:69347
Mailing Address - Country:US
Mailing Address - Phone:308-638-4483
Mailing Address - Fax:308-638-7385
Practice Address - Street 1:310 LINE DRIVE
Practice Address - Street 2:
Practice Address - City:HAY SPRINGS
Practice Address - State:NE
Practice Address - Zip Code:69347
Practice Address - Country:US
Practice Address - Phone:308-638-4483
Practice Address - Fax:308-638-7385
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist