Provider Demographics
NPI:1740592401
Name:CALLAHAN, AIKO C (DPT)
Entity Type:Individual
Prefix:
First Name:AIKO
Middle Name:C
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1030
Mailing Address - Country:US
Mailing Address - Phone:617-254-1656
Mailing Address - Fax:
Practice Address - Street 1:300 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1030
Practice Address - Country:US
Practice Address - Phone:617-254-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist