NPIMap

Organization Active NPI

Professional Therapies of Roanoke, Inc.

  • Rehabilitation Clinic/Center
  • Blacksburg, VA
National Provider Identifier
1336215367
Registry record updated Dec 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PROFESSIONAL THERAPIES OF ROANOKE, INC.
Practice address
1995 South Main Street
Suite 801
Blacksburg, VA 24060
Phone
(540) 951-2703
Fax
(540) 953-0873
NPI assigned
Nov 28, 2006
Reactivated
Nov 27, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brad C. Roush
Title
Executive Vice President
Phone
(419) 221-6712

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

1995 South Main Street
Suite 801
Blacksburg, VA 24060

Mailing address

1110 Shawnee Road
Lima, OH 45805
Phone (419) 221-6717

Other identifiers 2

IdentifierTypeStateIssuer
192427OtherVAANTHEM BCBS
29043OtherVASOUTHERN HEALTH

Other names 1

  • CORA Physical Therapy - Blacksburg Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Blacksburg Physical Therapy Associates11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

209 Roanoke St
Ste 1A
Christiansburg, VA 24073
Phone (540) 381-2722

712 Wenonah Ave
Ste 1
Pearisburg, VA 24134
Phone (549) 921-0026

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575417600000",
    "number": "1336215367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 SHAWNEE ROAD",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "45805",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 SOUTH MAIN STREET",
            "address_2": "SUITE 801",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "24060",
            "telephone_number": "540-951-2703",
            "fax_number": "540-953-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL THERAPIES OF ROANOKE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2019-12-04",
        "deactivation_date": "2019-11-08",
        "reactivation_date": "2019-11-27",
        "status": "A",
        "authorized_official_last_name": "ROUSH",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "419-221-6712",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "192427",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "29043",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Blacksburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blacksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.