Provider Demographics
NPI:1477612760
Name:VANHOOF, GREGORY MICHAEL (CPO)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:VANHOOF
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FAWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804
Mailing Address - Country:US
Mailing Address - Phone:203-740-8952
Mailing Address - Fax:203-740-8952
Practice Address - Street 1:12 FAWN RIDGE DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:203-740-8952
Practice Address - Fax:203-740-8952
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO 1530225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter