Provider Demographics
NPI:1811185416
Name:MARLO, CHRISTOPHER JORDAN (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JORDAN
Last Name:MARLO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 NE 816 AVE
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32680-2532
Mailing Address - Country:US
Mailing Address - Phone:352-542-3181
Mailing Address - Fax:
Practice Address - Street 1:2014 NW 11TH DR
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1919
Practice Address - Country:US
Practice Address - Phone:352-493-7776
Practice Address - Fax:352-493-0337
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist