Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 8972 | AZ |
NPI | 1235778101 |
---|---|
Provider Name | Jason M Callaman |
First Address | Phoenix, AZ 85014-2719 |
Second Address | Phoenix, AZ 85014-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2019 |
Last Update Date | 24/12/2019 |