Provider Demographics
NPI:1083388433
Name:BIALEK, CHRISTIAN MARK (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MARK
Last Name:BIALEK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 4TH RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-5520
Mailing Address - Country:US
Mailing Address - Phone:443-717-4314
Mailing Address - Fax:
Practice Address - Street 1:1232 RACE RD STE 203
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-2376
Practice Address - Country:US
Practice Address - Phone:410-918-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5544225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty