Healthcare Provider Details

I. General information

NPI: 1568603660
Provider Name (Legal Business Name): DONNA E. METZGER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 BRAEVIEW RD
LOUISVILLE KY
40206-2990
US

IV. Provider business mailing address

708 BRAEVIEW RD
LOUISVILLE KY
40206-2990
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-4587
  • Fax:
Mailing address:
  • Phone: 502-895-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number000307
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: