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General NPI Number Information
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NPI Number | 1639131592
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Entity Type | Individual
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Provider Name | GREG BERRY CPO CPED
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 1102 BROWN ST
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City | WASHINGTON
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State | NC
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Zip | 27889
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Country | US
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Telephone | 252-940-1203
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Fax | 252-940-1206
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Provider Business Mailing Address
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Address Line | 106 MEDICAL DRIVE PO BOX 1471
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City | ELIZ CITY
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State | NC
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Zip | 27909
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Country | US
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Telephone | 252-338-3002
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Fax | 252-338-2902
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | CPO1835
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | CPO1835
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | NC
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