Provider Demographics
NPI:1235216144
Name:METZROTH, STEFANIE NOELLE (PT)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:NOELLE
Last Name:METZROTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:STEFANIE
Other - Middle Name:NOELLE
Other - Last Name:HUNDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4312 CONAEM DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1909
Mailing Address - Country:US
Mailing Address - Phone:502-456-1424
Mailing Address - Fax:
Practice Address - Street 1:329 TOWNEPARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2348
Practice Address - Country:US
Practice Address - Phone:502-254-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist