Provider Demographics
NPI:1528044864
Name:MINNICH, BOYD MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:BOYD
Middle Name:MICHAEL
Last Name:MINNICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W MORRIS BLVD
Mailing Address - Street 2:STE 180
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2283
Mailing Address - Country:US
Mailing Address - Phone:423-586-6866
Mailing Address - Fax:423-581-9679
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:STE 180
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2283
Practice Address - Country:US
Practice Address - Phone:423-586-6866
Practice Address - Fax:423-581-9679
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0101380OtherBLUE CROSS BLUE SHIELD
TN3651249Medicaid
TN0101380OtherBLUE CROSS BLUE SHIELD