Healthcare Provider Details

I. General information

NPI: 1497245161
Provider Name (Legal Business Name): BLUE RIDGE BIOMECHANICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GLENN WILLOW DR UNIT 47
ARDEN NC
28704-0919
US

IV. Provider business mailing address

3001 BUTLER BRIDGE RD
MILLS RIVER NC
28759-3408
US

V. Phone/Fax

Practice location:
  • Phone: 828-338-3054
  • Fax:
Mailing address:
  • Phone: 828-338-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELIZABETH KOCH
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 828-338-3054