Provider Demographics
NPI:1457976730
Name:MUNK, TANNER LEE (DPT, PT)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:LEE
Last Name:MUNK
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 KECK ACRES
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND GAP
Mailing Address - State:TN
Mailing Address - Zip Code:37724-4226
Mailing Address - Country:US
Mailing Address - Phone:605-261-1517
Mailing Address - Fax:
Practice Address - Street 1:1615 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-5401
Practice Address - Country:US
Practice Address - Phone:423-317-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist