Provider Demographics
NPI:1063511715
Name:ROBERT N. METTAM, P.T., PHYSICAL THERAPIST, INC.
Entity Type:Organization
Organization Name:ROBERT N. METTAM, P.T., PHYSICAL THERAPIST, INC.
Other - Org Name:JMP PHYSICAL THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NIE
Authorized Official - Last Name:METTAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-789-3819
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91310-0278
Mailing Address - Country:US
Mailing Address - Phone:818-754-9549
Mailing Address - Fax:818-789-3546
Practice Address - Street 1:14116 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1119
Practice Address - Country:US
Practice Address - Phone:818-789-3819
Practice Address - Fax:818-789-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14480Medicare ID - Type UnspecifiedJMP PHYSICAL THERAPY