Provider Demographics
NPI:1356307763
Name:KORBA, CHRISTOPHER G (PT, ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:KORBA
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 CROWN VETCH DR
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 NORMAN DR
Practice Address - Street 2:SUITE B
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7495
Practice Address - Country:US
Practice Address - Phone:717-270-5465
Practice Address - Fax:717-270-5689
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011575L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS65165Medicare UPIN
PW20497Medicare ID - Type UnspecifiedMEDICARE #