Provider Demographics
NPI:1316431364
Name:WIMMER, MELVIN LEONARD III (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:LEONARD
Last Name:WIMMER
Suffix:III
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:4446 WASHINGTON RD STE 8
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-6361
Practice Address - Country:US
Practice Address - Phone:706-869-3352
Practice Address - Fax:706-869-3299
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9568225100000X
GAPT013399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist