Provider Demographics
NPI:1245346238
Name:MUTCHNIK, JAY M (PT)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:M
Last Name:MUTCHNIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 NEW PLANT CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3525
Mailing Address - Country:US
Mailing Address - Phone:410-654-8602
Mailing Address - Fax:
Practice Address - Street 1:5100 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 522
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4119
Practice Address - Country:US
Practice Address - Phone:202-966-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64628Medicare UPIN
DC00B312P52Medicare ID - Type UnspecifiedPHYSICAL THERAPY