NPIMap

Organization Active NPI

Blue Mountain Therapy, LLC

  • Early Intervention Provider Agency
  • Abingdon, VA
National Provider Identifier
1760818595
Registry record updated Jun 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
BLUE MOUNTAIN THERAPY, LLC
Practice address
17507 Lee Hwy
Abingdon, VA 24210-7835
Phone
(276) 525-6043
Fax
(888) 233-7885
NPI assigned
Sep 25, 2013
Last updated
Jun 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2022

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

Authorized official

Name
Joseph Clint Waddell
Title
Administration
Phone
(276) 525-6043

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X NU
Social Worker 104100000X NU
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU
Early Intervention Provider Agency 252Y00000X NU Primary

Addresses

Primary practice location

17507 Lee Hwy
Abingdon, VA 24210-7835

Mailing address

17507 Lee Hwy
Abingdon, VA 24210-7835
Phone (276) 525-6043

Other practice location 1

800 E Main St Ste 200
Wytheville, VA 24382-3322
Phone (276) 335-2217

Other practice location 2

686 Hwy 58 E
Norton, VA 24273
Phone (276) 525-6043

Other practice location 3

440 Park Ave NW
Norton, VA 24273-2114
Phone (276) 525-6043

Other practice location 4

27018 Lee Hwy
Abingdon, VA 24211
Phone (276) 525-4460

Other identifiers 1

IdentifierTypeStateIssuer
1760818595MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250303001354 VA Part B Supplier - Clinic/Group Practice 4789019944 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Norton, VA; Abingdon, VA; Wytheville, VA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

17507 Lee Hwy
Abingdon, VA 24210
Phone (276) 525-1338

686 Highway 58 E
Norton, VA 24273
Phone (276) 525-4460

Ownership & related parties

Subparts reporting this organization as parent 6

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1380067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655337600000",
    "number": "1760818595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17507 LEE HWY",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242107835",
            "telephone_number": "276-525-6043",
            "fax_number": "888-233-7885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17507 LEE HWY",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242107835",
            "telephone_number": "276-525-6043",
            "fax_number": "888-233-7885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E Main St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Wytheville",
            "state": "VA",
            "postal_code": "243823322",
            "country_code": "US",
            "telephone_number": "276-335-2217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "686 Hwy 58 E",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "24273",
            "country_code": "US",
            "telephone_number": "276-525-6043",
            "fax_number": "888-233-7885",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "440 Park Ave NW",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "242732114",
            "country_code": "US",
            "telephone_number": "276-525-6043",
            "fax_number": "888-233-7885",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27018 Lee Hwy",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "24211",
            "country_code": "US",
            "telephone_number": "276-525-4460",
            "fax_number": "888-233-7885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BLUE MOUNTAIN THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-25",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "CLINT",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "276-525-6043"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760818595",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Abingdon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; 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.