Healthcare Provider Details

I. General information

NPI: 1821585787
Provider Name (Legal Business Name): THAD GRABOWSKI BOCPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 E VIRGINIA BEACH BLVD
NORFOLK VA
23502-2851
US

IV. Provider business mailing address

6275 E VIRGINIA BEACH BLVD
NORFOLK VA
23502-2851
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-0671
  • Fax: 757-461-2073
Mailing address:
  • Phone: 757-461-0671
  • Fax: 757-461-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC21581
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberC21581
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: