MEDICARE: CHRISTINA CHA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	19171	MD

General Provider Information

NPI Number	:	1770845216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA CHA PT

Provider Business Mailing Address
First Line	:	3921 BEEKER MILL PL
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-3388
Country	:	US
Telephone Number	:	410-303-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 SAINT PAUL ST
Second Line	:	GROUND LEVEL
City	:	BALTIMORE
State	:	MD
Zip	:	21202-2618
Country	:	US
Telephone Number	:	410-685-7790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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Directions to “ CHRISTINA CHA PT” Practice Location

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