Provider Demographics
NPI:1659807634
Name:METZGER, RAYMOND DANIEL (PTA)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DANIEL
Last Name:METZGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6039
Mailing Address - Country:US
Mailing Address - Phone:309-737-6157
Mailing Address - Fax:
Practice Address - Street 1:1455 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1834
Practice Address - Country:US
Practice Address - Phone:309-281-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007713225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant