Healthcare Provider Details

I. General information

NPI: 1750874715
Provider Name (Legal Business Name): OLIVER N BEIRNE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4533 BRAMBLETON AVE
ROANOKE VA
24018-3436
US

IV. Provider business mailing address

4533 BRAMBLETON AVE
ROANOKE VA
24018-3436
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8022
  • Fax: 540-772-8022
Mailing address:
  • Phone: 540-772-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213989
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070023736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: