Healthcare Provider Details

I. General information

NPI: 1528324621
Provider Name (Legal Business Name): BLUE RIDGE ORTHOPAEDIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BELLE AIR LN
WARRENTON VA
20186-4368
US

IV. Provider business mailing address

PO BOX 316
OAKTON VA
22124-0316
US

V. Phone/Fax

Practice location:
  • Phone: 540-347-9220
  • Fax: 540-347-0492
Mailing address:
  • Phone: 800-521-8065
  • Fax: 703-842-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEFFRY HOLLIS
Title or Position: CEO
Credential:
Phone: 540-347-9220