Healthcare Provider Details

I. General information

NPI: 1396706065
Provider Name (Legal Business Name): BLUE RIDGE THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 MEMORIAL AVE
LYNCHBURG VA
24501-1708
US

IV. Provider business mailing address

1912 MEMORIAL AVE
LYNCHBURG VA
24501-1708
US

V. Phone/Fax

Practice location:
  • Phone: 434-845-8765
  • Fax: 434-845-8467
Mailing address:
  • Phone: 434-845-8765
  • Fax: 434-845-8467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY SHROCK
Title or Position: PRESIDENT
Credential: M.S., CCC-SLP
Phone: 434-845-8765