# BLUE RIDGE INTEGRATIVE WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164394177
- **Authorized official:** TRACY ROGERS OWNER (OWNER)
- **Authorized official phone:** (941) 391-7261

## Contact information

- **Practice address:** 512 DRYDEN LOOP, DRYDEN, VA 24243
- **Practice address phone:** (941) 391-7261
- **Mailing address:** 512 DRYDEN LOOP, DRYDEN, VA 24243-8366
- **Mailing address phone:** (252) 452-6075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 251E00000X | Home Health Agency | — | NULL | — |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/19/2025
- **Last updated:** 09/18/2026