Provider Demographics
NPI:1689809105
Name:MARKS, CHRISTIAN ROBERT (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ROBERT
Last Name:MARKS
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22157
Mailing Address - Street 2:
Mailing Address - City:LAKE BUENA VISTA
Mailing Address - State:FL
Mailing Address - Zip Code:32830-2157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1478 E BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:LAKE BUENA VISTA
Practice Address - State:FL
Practice Address - Zip Code:32830-8422
Practice Address - Country:US
Practice Address - Phone:407-934-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 31062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer