Provider Demographics
NPI:1861545238
Name:METZ, DAVID K (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:METZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1532 E PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7928
Mailing Address - Country:US
Mailing Address - Phone:417-881-4032
Mailing Address - Fax:417-881-4096
Practice Address - Street 1:1532 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7928
Practice Address - Country:US
Practice Address - Phone:417-881-4032
Practice Address - Fax:417-881-4096
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431935510 65804 A001OtherTRICARE
MO154652OtherBLUE CROSS
MO431935510 65804 A001OtherTRICARE