Provider Demographics
NPI:1649863259
Name:BALOG, SAMANTHA (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BALOG
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KRONENBITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 KENILWORTH DR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2201
Mailing Address - Country:US
Mailing Address - Phone:443-441-0637
Mailing Address - Fax:833-450-5086
Practice Address - Street 1:800 KENILWORTH DR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2201
Practice Address - Country:US
Practice Address - Phone:443-441-0637
Practice Address - Fax:833-450-5086
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0292792251X0800X
MD288382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic