Provider Demographics
NPI:1235139064
Name:KOROTKI, ROBIN GENENDLIS (PT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:GENENDLIS
Last Name:KOROTKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WEST RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2325
Mailing Address - Country:US
Mailing Address - Phone:410-825-0650
Mailing Address - Fax:410-823-9335
Practice Address - Street 1:21 WEST RD
Practice Address - Street 2:SUITE 105
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2325
Practice Address - Country:US
Practice Address - Phone:410-825-0650
Practice Address - Fax:410-823-9335
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ405RGOtherBLUE CROSS/BLUE SHIELD
MDCIGNAOtherCIGNA
MD1312639OtherJOHNS HOPKINS HEALTH
MD338388OtherALLIANCE
MDT223OtherBLUE SHIELD FEDERAL
MD338388OtherALLIANCE
MDT223OtherBLUE SHIELD FEDERAL