Provider Demographics
NPI:1710176490
Name:METTEER, LILLIAN ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ELIZABETH
Last Name:METTEER
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 1:900 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-2820
Mailing Address - Country:US
Mailing Address - Phone:805-924-1605
Mailing Address - Fax:805-924-1603
Practice Address - Street 1:900 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-2820
Practice Address - Country:US
Practice Address - Phone:805-924-1605
Practice Address - Fax:805-924-1603
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT7790OtherSTATE LICENSE