Provider Demographics
NPI:1811665029
Name:PINKERTON, CALLIE GRACE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:GRACE
Last Name:PINKERTON
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 1:108 N 18TH ST APT 108S
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-2418
Mailing Address - Country:US
Mailing Address - Phone:806-685-0988
Mailing Address - Fax:
Practice Address - Street 1:6801 BELL ST STE 1400
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7028
Practice Address - Country:US
Practice Address - Phone:806-355-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1351964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist