Provider Demographics
NPI:1821122078
Name:CALLAWAY, GREYDON BLAIR (PT, OCS)
Entity Type:Individual
Prefix:
First Name:GREYDON
Middle Name:BLAIR
Last Name:CALLAWAY
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:GRADY
Other - Middle Name:
Other - Last Name:CALLAWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, OCS
Mailing Address - Street 1:3500 OAK LAWN AVE
Mailing Address - Street 2:STE 670
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4399
Mailing Address - Country:US
Mailing Address - Phone:214-528-3378
Mailing Address - Fax:214-528-3379
Practice Address - Street 1:3131 TURTLE CREEK BLVD
Practice Address - Street 2:SUITE 615
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5405
Practice Address - Country:US
Practice Address - Phone:214-528-3378
Practice Address - Fax:214-528-3379
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1148889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist