Provider Demographics
NPI:1437224185
Name:BLUE RIDGE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BLUE RIDGE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MELCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:540-463-5888
Mailing Address - Street 1:25 CROSSING LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3724
Mailing Address - Country:US
Mailing Address - Phone:540-463-5888
Mailing Address - Fax:540-463-4406
Practice Address - Street 1:25 CROSSING LN
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3724
Practice Address - Country:US
Practice Address - Phone:540-463-5888
Practice Address - Fax:540-463-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192512OtherANTHEM PROVIDER NUMBER
VA192512OtherANTHEM PROVIDER NUMBER