MEDICARE: DAVID K. METZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	111654	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	431935510 65804 A001	OTHER	MO	TRICARE
2	154652	OTHER	MO	BLUE CROSS

General Provider Information

NPI Number	:	1861545238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID K. METZ PT

Provider Business Mailing Address
First Line	:	1532 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-7928
Country	:	US
Telephone Number	:	417-881-4032
Fax Number	:	417-881-4096

Provider Business Practice Location Address
First Line	:	1532 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-7928
Country	:	US
Telephone Number	:	417-881-4032
Fax Number	:	417-881-4096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	01/10/2008

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Directions to “ DAVID K. METZ PT” Practice Location

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