Provider Demographics
NPI:1558972430
Name:METTLER, AMELIA
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:METTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 VISTA WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4568
Mailing Address - Country:US
Mailing Address - Phone:760-729-7298
Mailing Address - Fax:760-729-7206
Practice Address - Street 1:3633 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4568
Practice Address - Country:US
Practice Address - Phone:760-729-7298
Practice Address - Fax:760-729-7206
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist