Healthcare Provider Details

I. General information

NPI: 1528722618
Provider Name (Legal Business Name): BLUE MOUNTAIN THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17507 LEE HWY
ABINGDON VA
24210-7835
US

IV. Provider business mailing address

17507 LEE HWY
ABINGDON VA
24210-7835
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax: 888-233-7885
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HOPE HENDERSON
Title or Position: HR
Credential:
Phone: 276-525-4460