Provider Demographics
NPI:1356606586
Name:BORGES HAUPTFUHRER, CHRISTINE LEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEE
Last Name:BORGES HAUPTFUHRER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 TOONE ST
Mailing Address - Street 2:#2161
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5173
Mailing Address - Country:US
Mailing Address - Phone:703-577-1992
Mailing Address - Fax:
Practice Address - Street 1:3901 NATIONAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1141
Practice Address - Country:US
Practice Address - Phone:301-421-1125
Practice Address - Fax:301-500-2175
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871376225100000X
MD26043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
249333YT9Medicare PIN
G02816Medicare PIN