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General NPI Number Information
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NPI Number | 1578798567
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Entity Type | Organization
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Legal Business Name | BRISTOL ORTHOTICS & PROSTHETICS, INC
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 113 SHORT ST SUITE 5
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City | POUNDING MILL
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State | VA
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Zip | 24637-4278
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Country | US
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Telephone | 276-963-7786
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Fax | 276-963-1187
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Provider Business Mailing Address
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Address Line | 553 HIGHWAY 126
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City | BRISTOL
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State | TN
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Zip | 37620-1685
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Country | US
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Telephone | 423-968-4442
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Fax | 423-968-4777
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Authorized Official
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Title or Position | CP
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Name | JOSHUA C GRAYBEAL
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Credential |
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Telephone | 423-968-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PRO0000000023
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License Number State | TN
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