| Organization Name: | SPORT AND SPINE REHAB OF CHEVY CHASE |
| NPI Number: | 1851548317 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID P THIBODEAUX (DOCTOR) |
| Mailing Address: | 5530 Wisconsin Ave Chevy Chase |
| State: | MD US |
| Postal Code: | 208154404 |
| Phone Number: | 3019861701 |
| Fax Number: | 2407660304 |
| NPI Enumeration Date: | 08/26/2008 |
| NPI Last Update Date: | 08/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 22286 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |