Provider Demographics
NPI:1356834519
Name:ASONGLEFAC, CHRISTINE MCLELLAN (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MCLELLAN
Last Name:ASONGLEFAC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANGELA
Other - Last Name:MCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 OAK MANOR DR
Mailing Address - Street 2:STE 101
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5553
Mailing Address - Country:US
Mailing Address - Phone:410-766-4878
Mailing Address - Fax:
Practice Address - Street 1:8638 VETERANS HWY FL 1
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1422
Practice Address - Country:US
Practice Address - Phone:443-481-6515
Practice Address - Fax:410-729-4526
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist