Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT1208 | AR |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT1208 | AR |
NPI | 1497713531 |
---|---|
Provider Name | Mark Gregory Calaway |
First Address | Little Rock, AR 72205-5202 |
Second Address | Little Rock, AR 72205-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 11/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00753833 | RRM (01) | AR |
PT1208 | ASB OF PT (01) | AR |