Provider Demographics
NPI:1417962713
Name:METZGER, KATHY VAN (PT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:VAN
Last Name:METZGER
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:PO BOX 1632
Mailing Address - Street 2:METZGER & MOLE PHYSICAL THERAPY
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-1632
Mailing Address - Country:US
Mailing Address - Phone:802-362-1334
Mailing Address - Fax:802-362-5344
Practice Address - Street 1:7252 ROUTE 7A, SUITE H
Practice Address - Street 2:METZGER & MOLE PHYSICAL THERAPY
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-1632
Practice Address - Country:US
Practice Address - Phone:802-362-1334
Practice Address - Fax:802-362-5344
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7998591OtherAETNA
VT1007642Medicaid
00002799OtherBLUE CROSS BLUE SHIELD VT
VT1007642Medicaid