NPIMap

Organization Active NPI

Lebanon Physical Therapy and Rehabilitative Services, LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Lebanon, VA
National Provider Identifier
1619947678
Registry record updated Aug 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
License
2305002098 Issued in VA
Legal business name
LEBANON PHYSICAL THERAPY AND REHABILITATIVE SERVICES, LLC
Practice address
272 Highland Drive
Lebanon, VA 24266-4623
Phone
(276) 889-4090
Fax
(276) 889-4026
NPI assigned
Jan 24, 2006
Last updated
Aug 23, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2007

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

Authorized official

Name
Mrs. Judith Easterly Lockridge, RPTNPI 1861520538
Title
Owner Physical Therapist
Phone
(276) 889-4090

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 2305002098 VA
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 2305002098 VA Primary

Addresses

Primary practice location

272 Highland Drive
Lebanon, VA 24266-4623

Mailing address

272 Highland Drive
P.O. Box 1387
Lebanon, VA 24266-4623
Phone (276) 889-4090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210809001484 VA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 6608968961 Practice locations: Abingdon, VA; Lebanon, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619947678. Details of each certification follow.

  • CCN 496639 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 496639

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LEBANON PHYSICAL THERAPY & REHABILITATIVE SERVICES
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Nov 6, 1996
Last certification
Jan 19, 2023
Ownership / control type
Proprietary
Facility address
272 Highland Drive
Lebanon, VA 24266

National Provider Directory

National Provider Directory

Locations

272 Highland Dr
Lebanon, VA 24266
Phone (276) 889-1737

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187827200000",
    "number": "1619947678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 HIGHLAND DRIVE",
            "address_2": "P.O. BOX 1387",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242664623",
            "telephone_number": "276-889-4090",
            "fax_number": "276-889-4026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "272 HIGHLAND DRIVE",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242664623",
            "telephone_number": "276-889-4090",
            "fax_number": "276-889-4026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON PHYSICAL THERAPY AND REHABILITATIVE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2007-08-23",
        "status": "A",
        "authorized_official_last_name": "LOCKRIDGE",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "EASTERLY",
        "authorized_official_title_or_position": "OWNER PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "276-889-4090",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "VA",
            "license": "2305002098",
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "VA",
            "license": "2305002098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, VA

Sources for this page

Verify at the official NPI Registry.