Provider Demographics
NPI:1639551849
Name:GRAYBEAL, JOSHUA (CP, LPO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GRAYBEAL
Suffix:
Gender:M
Credentials:CP, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:553 HIGHWAY 126
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1685
Practice Address - Country:US
Practice Address - Phone:423-968-4442
Practice Address - Fax:423-968-4777
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPRO0000000023332BC3200X, 335E00000X
TNORT0000000023332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier