Provider Demographics
NPI:1114224789
Name:BORK, KATIE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:
Last Name:BORK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 FRENCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-2902
Mailing Address - Country:US
Mailing Address - Phone:412-477-5992
Mailing Address - Fax:
Practice Address - Street 1:111 W HIGH ST STE 112
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5549
Practice Address - Country:US
Practice Address - Phone:410-392-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist