NPIMap

Organization Active NPI

Blue Ridge Physical Therapy, Inc

  • Physical Therapist
  • Independence, MO
National Provider Identifier
1477596500
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
R0420 Issued in MO
Legal business name
BLUE RIDGE PHYSICAL THERAPY, INC
Practice address
4900 S. Arrowhead Drive
Suite B
Independence, MO 64055-6990
Phone
(816) 795-6999
Fax
(816) 795-3366
NPI assigned
Jun 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Randy Westfall, PT, MTC
Title
Owner,President
Phone
(816) 795-6999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X R0420 MO Primary

Addresses

Primary practice location

4900 S. Arrowhead Drive
Suite B
Independence, MO 64055-6990

Mailing address

4900 S. Arrowhead Drive
Suite B
Independence, MO 64055-6990
Phone (816) 795-6999

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080604000059 MO Part B Supplier - Clinic/Group Practice 6305916263 Receives reassigned benefits from 11 practitioners
Practice locations: Independence, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477596500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 S. ARROWHEAD DRIVE",
            "address_2": "SUITE B",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556990",
            "telephone_number": "816-795-6999",
            "fax_number": "816-795-3366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 S. ARROWHEAD DRIVE",
            "address_2": "SUITE B",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556990",
            "telephone_number": "816-795-6999",
            "fax_number": "816-795-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WESTFALL",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "OWNER,PRESIDENT",
        "authorized_official_telephone_number": "816-795-6999",
        "authorized_official_credential": "PT, MTC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "R0420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.