Provider Demographics
NPI:1770760332
Name:BLUE RIDGE PHYSCIAL THERAPY
Entity type:Organization
Organization Name:BLUE RIDGE PHYSCIAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAW
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:828-268-9043
Mailing Address - Street 1:232 BOONE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4926
Mailing Address - Country:US
Mailing Address - Phone:828-268-9043
Mailing Address - Fax:828-268-9045
Practice Address - Street 1:232 BOONE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4926
Practice Address - Country:US
Practice Address - Phone:828-268-9043
Practice Address - Fax:828-268-9045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN REGIONAL HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0401282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural