Provider Demographics
NPI:1255602579
Name:MCKELVEY, MATTHEW WARNER (MS, ATC, PES)
Entity type:Individual
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First Name:MATTHEW
Middle Name:WARNER
Last Name:MCKELVEY
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Gender:M
Credentials:MS, ATC, PES
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Mailing Address - Street 1:620 MICHIGAN AVE NE
Mailing Address - Street 2:DUFOUR CENTER ROOM 108, SPORTS MED DEPT
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20064-0001
Mailing Address - Country:US
Mailing Address - Phone:202-319-6049
Mailing Address - Fax:202-319-4752
Practice Address - Street 1:3606 JOHN MCCORMACK DR NE
Practice Address - Street 2:ROOM 108
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20064-0001
Practice Address - Country:US
Practice Address - Phone:202-319-6049
Practice Address - Fax:202-319-4752
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer