Provider Demographics
NPI:1265662456
Name:METTLING, JASON RYAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:RYAN
Last Name:METTLING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12627 E CENTRAL AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2839
Mailing Address - Country:US
Mailing Address - Phone:316-260-3311
Mailing Address - Fax:316-219-5899
Practice Address - Street 1:12627 E CENTRAL AVE STE 308
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2839
Practice Address - Country:US
Practice Address - Phone:316-260-3311
Practice Address - Fax:316-260-6696
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1103951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265662456OtherNPI
1265662456OtherNPI