Provider Demographics
NPI:1629248240
Name:STEVEN G METTERNICH
Entity Type:Organization
Organization Name:STEVEN G METTERNICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:METTERNICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:217-826-2365
Mailing Address - Street 1:410 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-1010
Mailing Address - Country:US
Mailing Address - Phone:217-826-2365
Mailing Address - Fax:217-826-8120
Practice Address - Street 1:410 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1010
Practice Address - Country:US
Practice Address - Phone:217-826-2365
Practice Address - Fax:217-826-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDF1743OtherRAILROAD MEDICARE PIN
ILDF8520OtherNEW RAILROAD MEDICARE PIN
IL202039Medicare PIN