Provider Demographics
NPI:1417217357
Name:WIMBISH, GREGORY PAUL (L/CPO)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:PAUL
Last Name:WIMBISH
Suffix:
Gender:M
Credentials:L/CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2221
Mailing Address - Country:US
Mailing Address - Phone:972-923-2285
Mailing Address - Fax:972-923-1994
Practice Address - Street 1:105 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2221
Practice Address - Country:US
Practice Address - Phone:972-923-2285
Practice Address - Fax:972-923-1994
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX451222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist