Provider Demographics
NPI:1952843773
Name:CALLAHAN, MATTHEW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:M
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 1:2469 E FARRAND RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9173
Mailing Address - Country:US
Mailing Address - Phone:810-686-6797
Mailing Address - Fax:
Practice Address - Street 1:1429 FLUSHING RD STE A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2228
Practice Address - Country:US
Practice Address - Phone:810-487-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist