Provider Demographics
NPI:1205835519
Name:KIBBEY, CHARLES ARTHUR JR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ARTHUR
Last Name:KIBBEY
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 WISCONSIN AVE
Mailing Address - Street 2:STE B-1
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3530
Mailing Address - Country:US
Mailing Address - Phone:301-654-7383
Mailing Address - Fax:301-654-7897
Practice Address - Street 1:5480 WISCONSIN AVE
Practice Address - Street 2:STE B-1
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3530
Practice Address - Country:US
Practice Address - Phone:301-654-7383
Practice Address - Fax:301-654-7897
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4549679OtherAETNA
MD425731OtherBCBS
00A772KSSMedicare ID - Type Unspecified