Individual
MR. STEVEN GLEN METTERNICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3655 E MIRROR LAKE AVE, TERRE HAUTE, IN 47805-2138
(812) 645-4071
(866) 920-2133
Mailing address
3655 E MIRROR LAKE AVE, TERRE HAUTE, IN 47805-2138
(812) 645-4071
(866) 920-2133
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05001152A
IN
225100000X
Physical Therapist
070002318
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000-1232012
BLUE CROSS-KINTIC-INDIVIDUAL
IL
01
—
0001283001
BLUE CROSS BLUE SHIELD
IL
01
—
001541
HEALTH ALLIANCE
IL
01
—
010934666
KINETIC TAX ID
IL
01
—
1232012
BLUE CROSS 2010 KINETIC
IL
01
—
356107600
US DEPT OF LABOR
IL
01
—
650005686
RAILROAD MEDICARE UPIN
IL
Enumeration date
07/28/2006
Last updated
11/02/2012
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