Provider Demographics
NPI:1588759278
Name:METRICK, GLEN FRANKLIN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:FRANKLIN
Last Name:METRICK
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 COGNAC DR.
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-476-9166
Mailing Address - Fax:
Practice Address - Street 1:20451 S. TAMIAMI TRAIL
Practice Address - Street 2:SUITE 6
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-8101
Practice Address - Country:US
Practice Address - Phone:239-948-2222
Practice Address - Fax:239-948-2225
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 2683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y0813ZMedicare ID - Type Unspecified