1417962713 NPI number — KATHY VAN METZGER PT

Table of content: KATHY VAN METZGER PT (NPI 1417962713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417962713 NPI number — KATHY VAN METZGER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METZGER
Provider First Name:
KATHY
Provider Middle Name:
VAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417962713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1632
Provider Second Line Business Mailing Address:
METZGER & MOLE PHYSICAL THERAPY
Provider Business Mailing Address City Name:
MANCHESTER CENTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05255-1632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-362-1334
Provider Business Mailing Address Fax Number:
802-362-5344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7252 ROUTE 7A, SUITE H
Provider Second Line Business Practice Location Address:
METZGER & MOLE PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
MANCHESTER CENTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05255-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-362-1334
Provider Business Practice Location Address Fax Number:
802-362-5344
Provider Enumeration Date:
07/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0400002050 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7998591 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007642 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00002799 . This is a "BLUE CROSS BLUE SHIELD VT" identifier . This identifiers is of the category "OTHER".