Provider Demographics
NPI:1104922681
Name:GRAYBEAL, TERRY (CPO)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:GRAYBEAL
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 1:504 JUSTIS DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4287
Mailing Address - Country:US
Mailing Address - Phone:423-638-2670
Mailing Address - Fax:423-639-6592
Practice Address - Street 1:3845 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8241
Practice Address - Country:US
Practice Address - Phone:828-684-1644
Practice Address - Fax:828-684-0648
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X
TN224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3546804Medicaid
TN3546804Medicaid