Provider Demographics
NPI:1164169058
Name:METZGER, MICHAEL LEONARD (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEONARD
Last Name:METZGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6262 PALM VISTA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6950
Mailing Address - Country:US
Mailing Address - Phone:386-405-4292
Mailing Address - Fax:
Practice Address - Street 1:105 SOUTHPARK BLVD STE B201
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5159
Practice Address - Country:US
Practice Address - Phone:904-824-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic