Provider Demographics
NPI:1841379914
Name:BLUE RIDGE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:BLUE RIDGE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONTRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:423-262-0020
Mailing Address - Street 1:3915 BRISTOL HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1400
Mailing Address - Country:US
Mailing Address - Phone:423-262-0020
Mailing Address - Fax:423-262-0057
Practice Address - Street 1:3915 BRISTOL HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1400
Practice Address - Country:US
Practice Address - Phone:423-262-0020
Practice Address - Fax:423-262-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2422261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3651038Medicare ID - Type Unspecified