Healthcare Provider Details

I. General information

NPI: 1679411870
Provider Name (Legal Business Name): LUKE METZLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W DUNLAP AVE STE 145
PHOENIX AZ
85021-2813
US

IV. Provider business mailing address

1525 E BASELINE RD APT 75
TEMPE AZ
85283-1417
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034705
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: