Healthcare Provider Details

I. General information

NPI: 1639842206
Provider Name (Legal Business Name): JARED METZEN MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW 9TH ST
DES MOINES IA
50315-1909
US

IV. Provider business mailing address

450 LAUREL ST
DES MOINES IA
50314-3045
US

V. Phone/Fax

Practice location:
  • Phone: 515-242-7500
  • Fax:
Mailing address:
  • Phone: 515-323-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number120754
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: