Healthcare Provider Details

I. General information

NPI: 1982201497
Provider Name (Legal Business Name): CHRISTOPHER MUNGUIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N CHANCERY ST
MCMINNVILLE TN
37110-1604
US

IV. Provider business mailing address

PO BOX 681478
FRANKLIN TN
37068-1478
US

V. Phone/Fax

Practice location:
  • Phone: 931-474-1900
  • Fax: 931-474-1904
Mailing address:
  • Phone: 615-591-6590
  • Fax: 615-591-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13058
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: