Organization
EAST TENNESSEE COMPREHENSIVE REHABILITATION CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOYD MICHAEL MINNICH PT (PRESIDENT OWNER)
(423) 586-6866
Entity
Organization
Contact information
Practice address
420 W MORRIS BLVD, STE 180, MORRISTOWN, TN 37813
(423) 586-6866
(423) 581-9679
Mailing address
420 W MORRIS BLVD, STE 180, MORRISTOWN, TN 37813
(423) 586-6866
(423) 581-9679
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0000000751
TN
225100000X
Physical Therapist
2169
—
225100000X
Physical Therapist
5471
TN
225X00000X
Occupational Therapist
2734
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3651836PT
—
TN
05
—
3655603OT
—
TN
01
—
CL2481
RAIL ROAD MEDICARE
TN
Enumeration date
11/21/2006
Last updated
02/04/2008
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