Provider Demographics
NPI:1912254590
Name:CALLAGHAN, ZOLTAN (DPT)
Entity Type:Individual
Prefix:
First Name:ZOLTAN
Middle Name:
Last Name:CALLAGHAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY APT 6
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1933
Mailing Address - Country:US
Mailing Address - Phone:651-336-2807
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY APT 6
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1933
Practice Address - Country:US
Practice Address - Phone:651-336-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2706225100000X
MA19464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist