Provider Demographics
NPI:1699793489
Name:METZGER, JOHANNA MARIE (PT)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
Last Name:METZGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:MARIE
Other - Last Name:GREINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:455 W NORTHWEST HWY
Practice Address - Street 2:UNIT A
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6830
Practice Address - Country:US
Practice Address - Phone:847-381-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070017679OtherIL STATE LICENSE