Organization
BLUE RIDGE PHYSICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECCA W TANNER (OWNER)
(540) 772-8052
Entity
Organization
Contact information
Practice address
4582 FRANKLIN RD SW, ROANOKE, VA 24014-5144
(540) 772-8052
(540) 772-4508
Mailing address
4582 FRANKLIN RD SW, ROANOKE, VA 24014-5144
(540) 772-8052
(540) 772-4508
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6801510
—
VA
Enumeration date
09/24/2007
Last updated
09/24/2007
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