Provider Demographics
NPI:1831534502
Name:METHLAGL, NIELS G (PT)
Entity type:Individual
Prefix:
First Name:NIELS
Middle Name:G
Last Name:METHLAGL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 CAMINO DEL RIO S
Mailing Address - Street 2:STE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3762
Mailing Address - Country:US
Mailing Address - Phone:619-432-4634
Mailing Address - Fax:
Practice Address - Street 1:8401 COLESVILLE RD
Practice Address - Street 2:METRO LEVEL, SUITE 50
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3312
Practice Address - Country:US
Practice Address - Phone:301-588-7888
Practice Address - Fax:301-588-3419
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24451225100000X
CA39822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist