Healthcare Provider Details

I. General information

NPI: 1144333568
Provider Name (Legal Business Name): JACKIE K. WEIGAND HUTCHISON MPT, CST, BCIA-PMDB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7830 OLD GEORGETOWN RD
BETHESDA MD
20814-2432
US

IV. Provider business mailing address

3908 MADISON ST
HYATTSVILLE MD
20781-1749
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-0220
  • Fax: 301-654-0333
Mailing address:
  • Phone: 301-864-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20415
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: