Healthcare Provider Details

I. General information

NPI: 1770760332
Provider Name (Legal Business Name): BLUE RIDGE PHYSCIAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 BOONE HEIGHTS DR
BOONE NC
28607-4926
US

IV. Provider business mailing address

232 BOONE HEIGHTS DR
BOONE NC
28607-4926
US

V. Phone/Fax

Practice location:
  • Phone: 828-268-9043
  • Fax: 828-268-9045
Mailing address:
  • Phone: 828-268-9043
  • Fax: 828-268-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number0401
License Number StateNC

VIII. Authorized Official

Name: SHIRLEY FAW
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 828-268-9043