Provider Demographics
NPI:1598065765
Name:MCMINNVILLE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MCMINNVILLE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:931-474-7755
Mailing Address - Street 1:2391 S CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-3614
Mailing Address - Country:US
Mailing Address - Phone:931-474-7755
Mailing Address - Fax:931-474-7758
Practice Address - Street 1:2391 S CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-3614
Practice Address - Country:US
Practice Address - Phone:931-474-7755
Practice Address - Fax:931-474-7758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8536261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy