NPIMap

Organization Active NPI

Sport and Spine Rehab of Chevy Chase

  • Physical Therapist
  • Chevy Chase, MD
National Provider Identifier
1851548317
Registry record updated Aug 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22286 Issued in MD
Legal business name
SPORT AND SPINE REHAB OF CHEVY CHASE
Practice address
5530 Wisconsin Ave
Chevy Chase, MD 20815-4404
Phone
(301) 986-1701
Fax
(240) 766-0304
NPI assigned
Aug 26, 2008
Last updated
Aug 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David P Thibodeaux, PTNPI 1578750139
Title
Doctor
Phone
(240) 766-0300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 22286 MD Primary

Addresses

Primary practice location

5530 Wisconsin Ave
Chevy Chase, MD 20815-4404

Mailing address

11418 Livingston Rd
Ft Washington, MD 20744-5145
Phone (240) 766-0300

Other identifiers 3

IdentifierTypeStateIssuer
718214OtherMDACN
A518OtherDCBCBS NCA
0700SPOtherMDBCBS OF MD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1851548317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11418 LIVINGSTON RD",
            "city": "FT WASHINGTON",
            "state": "MD",
            "postal_code": "207445145",
            "telephone_number": "240-766-0300",
            "fax_number": "240-766-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5530 WISCONSIN AVE",
            "city": "CHEVY CHASE",
            "state": "MD",
            "postal_code": "208154404",
            "telephone_number": "301-986-1701",
            "fax_number": "240-766-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT AND SPINE REHAB OF CHEVY CHASE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "THIBODEAUX",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "240-766-0300",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "22286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "718214",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NCA",
            "identifier": "A518",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MD",
            "identifier": "0700SP",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chevy Chase, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.