Provider Demographics
NPI:1164643177
Name:FRITSCH, CHRISTINE ALLYN GEBAUER
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALLYN GEBAUER
Last Name:FRITSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LOG CANOE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666
Mailing Address - Country:US
Mailing Address - Phone:410-604-2162
Mailing Address - Fax:
Practice Address - Street 1:155 LOG CANOE CIRCLE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666
Practice Address - Country:US
Practice Address - Phone:410-604-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD153MK816Medicare ID - Type Unspecified