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NPI Code Detail

MEDICARE: TERRY GRAYBEAL C.P.O.

MEDICARE: TERRY GRAYBEAL C.P.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Z00000XOrthotist
2224P00000XProsthetistTN

General Provider Information

NPI Number : 1104922681
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY GRAYBEAL C.P.O.
Provider Business Mailing Address
First Line : 504 JUSTIS DR
Second Line :
City : GREENEVILLE
State : TN
Zip : 37745-4287
Country : US
Telephone Number : 423-638-2670
Fax Number : 423-639-6592
Provider Business Practice Location Address
First Line : 3845 HENDERSONVILLE RD
Second Line :
City : FLETCHER
State : NC
Zip : 28732-8241
Country : US
Telephone Number : 828-684-1644
Fax Number : 828-684-0648
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 12/04/2018

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