Provider Demographics
NPI:1750909669
Name:VAN METER, MERCEDES (DPT)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:VAN METER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 SAN MATEO BLVD NE APT A10
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6223
Mailing Address - Country:US
Mailing Address - Phone:480-751-9004
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST NW STE I
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4866
Practice Address - Country:US
Practice Address - Phone:505-865-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist