Organization
EAST TENNESSEE COMPREHENSIVE REHABILITATION CENTER INC
Active
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
Update your record
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