Provider Demographics
NPI:1144333568
Name:HUTCHISON, JACKIE K WEIGAND (MPT, CST, BCIA-PMDB)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:K WEIGAND
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:MPT, CST, BCIA-PMDB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1749
Mailing Address - Country:US
Mailing Address - Phone:301-864-0973
Mailing Address - Fax:
Practice Address - Street 1:7830 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2432
Practice Address - Country:US
Practice Address - Phone:301-656-0220
Practice Address - Fax:301-654-0333
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist