Healthcare Provider Details

I. General information

NPI: 1881737179
Provider Name (Legal Business Name): BLUE RIDGE PHYSICAL AND HAND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N CLEVELAND AVE
HAGERSTOWN MD
21740-5000
US

IV. Provider business mailing address

227 N CLEVELAND AVE
HAGERSTOWN MD
21740-5000
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-3844
  • Fax:
Mailing address:
  • Phone: 301-733-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TODD M ANDERSON
Title or Position: OWNER
Credential: OT
Phone: 301-733-3844