MEDICARE: BLUE RIDGE PELVIC HEALTH

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
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1922875913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE PELVIC HEALTH

Provider Business Mailing Address
First Line	:	4502 STARKEY RD STE 5
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8517
Country	:	US
Telephone Number	:	540-314-0647
Fax Number	:

Provider Business Practice Location Address
First Line	:	4903 STARKEY RD STE 100B
Second Line	:
City	:	CAVE SPRING
State	:	VA
Zip	:	24018-8525
Country	:	US
Telephone Number	:	540-929-1339
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CHELSEA ANN LILLER
Credential	:	MOTR/L
Telephone Number	:	540-314-0647

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	09/27/2024

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