Provider Demographics
NPI:1205500287
Name:CALLAHAM, CHRISTY (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:CALLAHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:3120 SEMINOLE LOOP
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38572-6402
Mailing Address - Country:US
Mailing Address - Phone:931-200-3975
Mailing Address - Fax:
Practice Address - Street 1:55 W LAKE RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38385
Practice Address - Country:US
Practice Address - Phone:931-297-9943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3689225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant