Healthcare Provider Details

I. General information

NPI: 1699397745
Provider Name (Legal Business Name): LISA MARIE METZGER ATC, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7169 KALAMAZOO AVE SE STE 200
CALEDONIA MI
49316-8146
US

IV. Provider business mailing address

PO BOX 30516
LANSING MI
48909-8016
US

V. Phone/Fax

Practice location:
  • Phone: 616-827-3010
  • Fax:
Mailing address:
  • Phone: 616-608-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501303460
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: