Provider Demographics
NPI:1730814625
Name:BODE, CHRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BODE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OWINGS GATE RD APT T2
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3552
Mailing Address - Country:US
Mailing Address - Phone:443-622-3547
Mailing Address - Fax:
Practice Address - Street 1:5901 HOLABIRD AVE STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6015
Practice Address - Country:US
Practice Address - Phone:410-288-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19888225100000X, 2251H1300X
CA302205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist