Provider Demographics
NPI:1215484712
Name:METZ MASSAGE THERAPY
Entity type:Organization
Organization Name:METZ MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:JOSEF
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-531-6048
Mailing Address - Street 1:1133 NORTH 14TH AVE.
Mailing Address - Street 2:#103
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:970-531-6048
Mailing Address - Fax:
Practice Address - Street 1:626 S. FERGUSON AVE.
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:970-531-6048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-7967305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service