Active NPI
Charles Robert Calloway, LPTA
- Physical Therapy Assistant
- Saint Joseph, MO
National Provider Identifier
1750614772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1400700
- Practice address
- 4408 Kensington Dr
Saint Joseph, MO 64506-5064 - Phone
- (816) 383-1715
- NPI assigned
- Sep 9, 2009
- Sex
- Male
- Sole proprietor
- No
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 Therapy Assistant | 225200000X | 1400700 | KS | Primary |
Addresses
Primary practice location
4408 Kensington Dr
Saint Joseph, MO 64506-5064
Mailing address
4408 Kensington Dr.
St. Joseph, MO 64506
Phone (816) 383-1715
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 |
|---|---|---|---|
| 1400700 | KS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252454400000",
"number": "1750614772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4408 KENSINGTON DR.",
"city": "ST. JOSEPH",
"state": "MO",
"postal_code": "64506",
"telephone_number": "816-383-1715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4408 KENSINGTON DR",
"city": "SAINT JOSEPH",
"state": "MO",
"postal_code": "645065064",
"telephone_number": "816-383-1715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLOWAY",
"first_name": "CHARLES",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-09",
"last_updated": "2009-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KS",
"license": "1400700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Joseph, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.