Healthcare Provider Details

I. General information

NPI: 1922875913
Provider Name (Legal Business Name): BLUE RIDGE PELVIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4903 STARKEY RD STE 100B
CAVE SPRING VA
24018-8525
US

IV. Provider business mailing address

4502 STARKEY RD STE 5
ROANOKE VA
24018-8517
US

V. Phone/Fax

Practice location:
  • Phone: 540-929-1339
  • Fax:
Mailing address:
  • Phone: 540-314-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHELSEA ANN LILLER
Title or Position: OWNER
Credential: MOTR/L
Phone: 540-314-0647