Provider Demographics
NPI:1265730857
Name:METZ, NICHOLAS S (ATC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:METZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE J
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4724
Mailing Address - Country:US
Mailing Address - Phone:253-752-7522
Mailing Address - Fax:253-759-3552
Practice Address - Street 1:2603 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE J
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4724
Practice Address - Country:US
Practice Address - Phone:253-752-7522
Practice Address - Fax:253-759-3552
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1 601792992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer