NPI 1356772305

Anna Ellesor Gray Detweiler, CPO

Practitioner Prosthetist Norfolk, VA

Practice location

Address: 6320 N Center Dr Bldg 15 Suite 201, Norfolk, VA 23502-4009
Phone: (757) 892-5300
Fax: (757) 892-5303

Registered specialties (2)

Prosthetist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224P00000X

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Orthotist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X

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Registry record

NPI: 1356772305
Entity type: Individual
Sex (as registered): Female
NPI issued: 2 Dec 2013
Record last updated: 10 Jan 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.