Basic Information
Provider Information
NPI: 1255730065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: METZGER
FirstName: JENNA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 920 4TH ST
Address2:  
City: GARRETSON
State: SD
PostalCode: 570302006
CountryCode: US
TelephoneNumber: 6055943466
FaxNumber: 6055946662
Practice Location
Address1: 920 4TH ST
Address2:  
City: GARRETSON
State: SD
PostalCode: 570302006
CountryCode: US
TelephoneNumber: 6055943466
FaxNumber: 6055946662
Other Information
ProviderEnumerationDate: 08/18/2014
LastUpdateDate: 08/18/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1603SDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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