MEDICARE: MR. JAY M. MUTCHNIK P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT870265	DC

General Provider Information

NPI Number	:	1245346238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY M. MUTCHNIK P.T.

Provider Business Mailing Address
First Line	:	20 NEW PLANT CT
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3525
Country	:	US
Telephone Number	:	410-654-8602
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 WISCONSIN AVE NW
Second Line	:	SUITE 522
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4119
Country	:	US
Telephone Number	:	202-966-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/09/2007

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