Provider Demographics
NPI:1780292748
Name:ROETHLE, CHRISTINA ELIZABETH
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:ROETHLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ELIZABETH
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7131 ARLINGTON RD APT 341
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2966
Mailing Address - Country:US
Mailing Address - Phone:443-791-8884
Mailing Address - Fax:
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE STE 158
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8337
Practice Address - Country:US
Practice Address - Phone:301-662-6790
Practice Address - Fax:301-662-6805
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT872650225100000X
MD28074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist