Provider Demographics
NPI:1326147364
Name:METTEN, PATRICIA JO (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JO
Last Name:METTEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1512
Mailing Address - Country:US
Mailing Address - Phone:502-458-3179
Mailing Address - Fax:502-458-3179
Practice Address - Street 1:1404 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1512
Practice Address - Country:US
Practice Address - Phone:502-458-3179
Practice Address - Fax:502-458-3179
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0004122251X0800X
IA017072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY692467OtherUNITED HEALTHCARE
KY2157129OtherFIRST HEALTH
KY000000042993OtherANTHEM
KY5019501Medicare ID - Type UnspecifiedMEDICARE