Provider Demographics
NPI:1164175469
Name:METHLIE, DAVID ROBERT II (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:METHLIE
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CHARLESFAX CT
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-8533
Mailing Address - Country:US
Mailing Address - Phone:850-541-3085
Mailing Address - Fax:
Practice Address - Street 1:3611 TRANSMITTER RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-9799
Practice Address - Country:US
Practice Address - Phone:850-541-3085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA30605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist