CTL of VA LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

CTL OF VA LLC

Doing business as

Joint Regeneration Group of Blacksburg

Practice address

210 Professional Park Dr SE Ste 9
Blacksburg, VA 24060-6649

Phone

(904) 616-3040

NPI assigned

Oct 27, 2022

Organization subpart

No

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

Authorized official

Name

Robert Kenny

Title

Authorized Official

Phone

(904) 576-0786

Specialties & licenses 1

Addresses

Other names 1

• Joint Regeneration Group of Blacksburg Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 6

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

• Christine K Davidson, RN, MS, NP-C

  • Adult Health Nurse Practitioner
  • Roanoke, VA
  • NPI 1588902761
  Medicare reassignment NPD
• Renette Davis, FNP

  • Family Nurse Practitioner
  • Roanoke, VA
  • NPI 1962423368
  Medicare reassignment NPD
• Matthew Bernard Fulton, DO

  • Anesthesiology Physician
  • Roanoke, VA
  • NPI 1609814441
  Medicare reassignment NPD
• Vera J. Short

  • Family Nurse Practitioner
  • Roanoke, VA
  • NPI 1104325778
  Medicare reassignment NPD
• Jeff Stephens, NP

  • Family Nurse Practitioner
  • Roanoke, VA
  • NPI 1811916786
  Medicare reassignment NPD
• Meredith Constance Galt, PA-C

  • Medical Physician Assistant
  • Barboursville, WV
  • NPI 1063849032

  VA

  Medicare reassignment

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679356800000",
    "number": "1700503992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 PROFESSIONAL PARK DR SE STE 9",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606649",
            "telephone_number": "904-616-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 PROFESSIONAL PARK DR SE STE 9",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606649",
            "telephone_number": "904-616-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CTL OF VA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-27",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A",
        "authorized_official_last_name": "KENNY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "904-576-0786"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.jrgofblacksburg.com",
            "affiliation": "N",
            "endpointDescription": "ISP",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "210 Professional Park Dr SE Ste 9",
            "city": "Blacksburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240606649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Joint Regeneration Group of Blacksburg",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Joint Regeneration Group of Blacksburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Boyd Crawford, ATC
• Michael Alva Crawley
• Andrew Monroe Cross II, MD
• Roy Howard Crouse, PHD
• Graciela Cruz
• Kayla Cumberland, LPC
• Toshia Najar Curfiss, LPC
• Heather Mitchell Custer, MS, LPC
• Rebecca Cutter
• Cole Dain, MD

• Physical Medicine & Rehabilitation Physician in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Physical Medicine & Rehabilitation Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; 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.