Provider Demographics
NPI:1699027946
Name:MABRY, CALLIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1240
Mailing Address - Country:US
Mailing Address - Phone:606-325-7955
Mailing Address - Fax:606-325-9848
Practice Address - Street 1:710 N CAROL MALONE BLVD STE A
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1126
Practice Address - Country:US
Practice Address - Phone:606-474-0157
Practice Address - Fax:606-474-0890
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT006088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist