NPIMap

Organization Active NPI

Blue Ridge Therapy Associates, Inc.

  • Rehabilitation Clinic/Center
  • Lynchburg, VA
National Provider Identifier
1396706065
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
BLUE RIDGE THERAPY ASSOCIATES, INC.
Practice address
1912 Memorial Ave
Lynchburg, VA 24501-1708
Phone
(434) 845-8765
Fax
(434) 845-8467
NPI assigned
Mar 31, 2006
Last updated
Aug 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Authorized official

Name
Amy Shrock, M.S., CCC-SLPNPI 1588627665
Title
President
Phone
(434) 845-8765

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary
Physical Therapist 225100000X
Rehabilitation Practitioner 225400000X
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

1912 Memorial Ave
Lynchburg, VA 24501-1708

Mailing address

1912 Memorial Ave
Lynchburg, VA 24501-1708
Phone (434) 845-8765

Other identifiers 5

IdentifierTypeStateIssuer
192596OtherVAANTHEM OT
192597OtherVAANTHEM ST
192595OtherVAANTHEM PT
QPA413MedicaidSC
004978757MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120627000362 VA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 6608804786 Practice locations: Lynchburg, VA

National Provider Directory

National Provider Directory
Tax ID family
Blue Ridge Therapy Associates Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1396706065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 MEMORIAL AVE",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011708",
            "telephone_number": "434-845-8765",
            "fax_number": "434-845-8467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 MEMORIAL AVE",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011708",
            "telephone_number": "434-845-8765",
            "fax_number": "434-845-8467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE THERAPY ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "SHROCK",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "434-845-8765",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM OT",
            "identifier": "192596",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ST",
            "identifier": "192597",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PT",
            "identifier": "192595",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "QPA413",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004978757",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynchburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.