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General NPI Number Information
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NPI Number | 1568537363
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE COMPREHENSIVE REHABILITATION CENTER INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 420 W MORRIS BLVD STE 180
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City | MORRISTOWN
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State | TN
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Zip | 37813
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Country | US
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Telephone | 423-586-6866
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Fax | 423-581-9679
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Provider Business Mailing Address
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Address Line | 420 W MORRIS BLVD STE 180
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City | MORRISTOWN
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State | TN
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Zip | 37813
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Country | US
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Telephone | 423-586-6866
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Fax | 423-581-9679
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. BOYD MICHAEL MINNICH
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Credential | PT
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Telephone | 423-586-6866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2734
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2169
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5471
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0000000751
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License Number State | TN
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