Organization
PROFESSIONAL THERAPIES OF ROANOKE, INC.
Active
Other names
CORA Physical Therapy - Blacksburg
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD C. ROUSH (EXECUTIVE VICE PRESIDENT)
(419) 221-6712
Entity
Organization
Contact information
Practice address
1995 SOUTH MAIN STREET, SUITE 801, BLACKSBURG, VA 24060
(540) 951-2703
(540) 953-0873
Mailing address
1110 SHAWNEE ROAD, LIMA, OH 45805
(419) 221-6717
(419) 222-0507
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192427
ANTHEM BCBS
VA
01
—
29043
SOUTHERN HEALTH
VA
Enumeration date
11/28/2006
Last updated
12/04/2019
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