Healthcare Provider Details

I. General information

NPI: 1538892997
Provider Name (Legal Business Name): CALEB JOSHUA ROOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 LEESVILLE RD
LYNCHBURG VA
24502-2828
US

IV. Provider business mailing address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5262
  • Fax:
Mailing address:
  • Phone: 434-200-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010942
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: