Provider Demographics
NPI:1487165023
Name:KORBELAK, CHRISTIANA MICHELLE
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:MICHELLE
Last Name:KORBELAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:MICHELLE
Other - Last Name:GROSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6914 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1747
Mailing Address - Country:US
Mailing Address - Phone:410-284-5441
Mailing Address - Fax:410-284-5442
Practice Address - Street 1:1205 YORK RD STE 19
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6211
Practice Address - Country:US
Practice Address - Phone:410-296-9195
Practice Address - Fax:410-296-9197
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist