Provider Demographics
NPI:1437563665
Name:BRISTOL ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:BRISTOL ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:WILL
Authorized Official - Last Name:GRAYBEAL
Authorized Official - Suffix:
Authorized Official - Credentials:CP,LPO
Authorized Official - Phone:423-968-4442
Mailing Address - Street 1:553 HIGHWAY 126
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1685
Mailing Address - Country:US
Mailing Address - Phone:423-968-4442
Mailing Address - Fax:423-968-4777
Practice Address - Street 1:921 BROAD ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3801
Practice Address - Country:US
Practice Address - Phone:423-968-4442
Practice Address - Fax:423-968-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier