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NPI Code Detail

MEDICARE: MELVIN LEONARD WIMMER III PT, DPT

MEDICARE: MELVIN LEONARD WIMMER III PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist9568SC
2225100000XPhysical TherapistPT013399GA

General Provider Information

NPI Number : 1316431364
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELVIN LEONARD WIMMER III PT, DPT
Provider Business Mailing Address
First Line : 6397 LEE HWY STE 300
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-2564
Country : US
Telephone Number : 423-238-7217
Fax Number : 423-362-8684
Provider Business Practice Location Address
First Line : 4446 WASHINGTON RD STE 8
Second Line :
City : EVANS
State : GA
Zip : 30809-6361
Country : US
Telephone Number : 706-869-3352
Fax Number : 706-869-3299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2018
Last Update Date : 05/30/2019

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