Provider Demographics
NPI:1023190758
Name:KITCHEN, JOHN MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20528 BOLAND FARM RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4021
Mailing Address - Country:US
Mailing Address - Phone:301-528-8096
Mailing Address - Fax:301-528-8083
Practice Address - Street 1:20528 BOLAND FARM RD
Practice Address - Street 2:SUITE 111
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4021
Practice Address - Country:US
Practice Address - Phone:301-528-8096
Practice Address - Fax:301-528-8083
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7654166OtherAETNA
64382802OtherCARE FIRST
DC0001OtherBCBS DC
MD47610168OtherBLUE CROSS BLUE SHIELD
7654166OtherAETNA