Provider Demographics
NPI:1871957522
Name:BLUE RIDGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:BLUE RIDGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:816-739-0884
Mailing Address - Street 1:4900 S ARROWHEAD DR
Mailing Address - Street 2:STE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6952
Mailing Address - Country:US
Mailing Address - Phone:816-739-0884
Mailing Address - Fax:816-795-3366
Practice Address - Street 1:373 W 101ST TER
Practice Address - Street 2:STE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4408
Practice Address - Country:US
Practice Address - Phone:816-739-0884
Practice Address - Fax:816-795-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115120261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy