Provider Demographics
NPI:1770845216
Name:CHA, CHRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:CHA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 BEEKER MILL PL
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3388
Mailing Address - Country:US
Mailing Address - Phone:410-303-5520
Mailing Address - Fax:
Practice Address - Street 1:1120 SAINT PAUL ST
Practice Address - Street 2:GROUND LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2618
Practice Address - Country:US
Practice Address - Phone:410-685-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist