Active NPI
Kimberly Christine Callahan, DPT
- Physical Therapist
- Roscoe, IL
National Provider Identifier
1154636108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1408
- Practice address
- 618 Ashleigh LN
Roscoe, IL 61073-6419 - Phone
- (779) 771-4657
- NPI assigned
- Aug 15, 2010
- Last updated
- Nov 1, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1408 | PR | Primary |
Addresses
Primary practice location
618 Ashleigh LN
Roscoe, IL 61073-6419
Mailing address
618 Ashleigh LN
Roscoe, IL 61073-6419
Phone (779) 771-4657
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1408 | PR | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698796800000",
"number": "1154636108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "618 ASHLEIGH LN",
"city": "ROSCOE",
"state": "IL",
"postal_code": "610736419",
"telephone_number": "779-771-4657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "618 ASHLEIGH LN",
"city": "ROSCOE",
"state": "IL",
"postal_code": "610736419",
"telephone_number": "779-771-4657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLAHAN",
"first_name": "KIMBERLY",
"middle_name": "CHRISTINE",
"name_prefix": "Mrs.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-15",
"last_updated": "2023-11-01",
"certification_date": "2023-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PR",
"license": "1408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roscoe, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.