Provider Demographics
NPI:1013491158
Name:METZ, TANNER J (LMT)
Entity Type:Individual
Prefix:MR
First Name:TANNER
Middle Name:J
Last Name:METZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 W BROADWATER ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-1909
Mailing Address - Country:US
Mailing Address - Phone:406-539-4247
Mailing Address - Fax:
Practice Address - Street 1:626 S FERGUSON AVE STE 4
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6409
Practice Address - Country:US
Practice Address - Phone:406-539-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-7967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist