Provider Demographics
NPI:1265785026
Name:METZGER, LAURIE R (PTA)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:R
Last Name:METZGER
Suffix:
Gender:F
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-0280
Mailing Address - Country:US
Mailing Address - Phone:775-783-7606
Mailing Address - Fax:
Practice Address - Street 1:931 MICA DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7169
Practice Address - Country:US
Practice Address - Phone:775-267-3396
Practice Address - Fax:775-267-3398
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-0434225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant