Provider Demographics
NPI:1518196658
Name:METIVIER, JAMES CHRISTOPHER (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:METIVIER
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 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1555
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-951-8593
Mailing Address - Fax:301-951-8598
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1555
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-951-8593
Practice Address - Fax:301-951-8598
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
159374ZECCMedicare PIN