Professional Rehab Associates, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305001727 Issued in VA

Legal business name

PROFESSIONAL REHAB ASSOCIATES, INC

Practice address

1200 Tyler Ave
Radford, VA 24141

Phone

(540) 639-5786

Fax

(540) 633-0787

NPI assigned

Sep 13, 2006

Last updated

Apr 30, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathleen L Stewart, MS PTNPI 1477559813

Title

President

Phone

(540) 639-5786

Specialties & licenses 9

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 21

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.

• Kathleen Stewart, PT

  • Physical Therapist
  • Christiansburg, VA
  • NPI 1477559813
  NPD (past) Authorized official
• Sarah Beth Dolinger, PT. DPT

  • Physical Therapist
  • Radford, VA
  • NPI 1922792381
  NPD
• Abigail Lynn Hickman, DPT

  • Physical Therapist
  • Radford, VA
  • NPI 1265257299
  NPD
• Allison Pertee

  • Physical Therapist
  • Radford, VA
  • NPI 1265310353
  NPD
• Maryah D Sydnor, PT

  • Physical Therapist
  • Radford, VA
  • NPI 1093593261
  NPD
• Susan N Baker, PT

  • Physical Therapist
  • Christiansburg, VA
  • NPI 1598711343
  NPD (past)
• Mary Bennett, MOTR

  • Occupational Therapist
  • Christiansburg, VA
  • NPI 1023568011
  NPD (past)
• Therese Bowen, OTR/L

  • Occupational Therapist
  • Kilmarnock, VA
  • NPI 1326471335
  NPD (past)
• Debora Ann Brumback, OTR

  • Physical Rehabilitation Occupational Therapist
  • Christiansburg, VA
  • NPI 1992048599
  NPD (past)
• Laura Dehart Buzzard, SLP

  • Speech-Language Pathologist
  • Christiansburg, VA
  • NPI 1174884936
  NPD (past)
• Frederick B First, PT

  • Physical Therapist
  • Christiansburg, VA
  • NPI 1912954876
  NPD (past)
• Kristin Ashley Goodridge, DPT

  • Physical Therapist
  • Christiansburg, VA
  • NPI 1427304484
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1487759957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 TYLER AVE",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "24141",
            "telephone_number": "540-639-5786",
            "fax_number": "540-633-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 TYLER AVE",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "24141",
            "telephone_number": "540-639-5786",
            "fax_number": "540-633-0787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "595 N Franklin St",
            "address_purpose": "LOCATION",
            "city": "Christiansburg",
            "state": "VA",
            "postal_code": "240731915",
            "country_code": "US",
            "telephone_number": "540-639-5786",
            "fax_number": "540-633-0787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL REHAB ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-639-5786",
        "authorized_official_credential": "MS PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305001794",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305005543",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305001727",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": "119004079",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": "119001896",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202002486",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202000928",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202001771",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202004624",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004978803",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gwynn Johnson Polidoro, LCSW
• Elizabeth Bartley Poor, NP
• Noa Ruth Powell
• Kourtney Powers
• Mindy Rene Prescott, NP
• Professional Therapies of Roanoke, Inc. (CORA Physical Therapy - Radford)
• Psychological Works, LLC
• Virginia Puckett, LPC
• Pyramid Healthcare, Inc.
• Quest Diagnostics Clinical Laboratories Inc

• Physical Therapist in Radford, VA
• Providers in Radford, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.