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General NPI Number Information
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NPI Number | 1083192595
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE INTEGRATIVE WELLNESS LLC
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 512 DRYDEN LOOP
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City | DRYDEN
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State | VA
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Zip | 24243
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Country | US
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Telephone | 252-832-1588
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Fax | 276-246-1658
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Provider Business Mailing Address
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Address Line | 189 DINSMORE RD
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City | DRYDEN
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State | VA
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Zip | 24243-8378
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Country | US
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Telephone | 276-832-1588
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Fax | 276-246-1658
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Authorized Official
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Title or Position | PROJECT DIRECTOR
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Name | MR. RODNEY TERRY
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Credential |
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Telephone | 252-452-6075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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