Individual
ANNA ELLESOR GRAY DETWEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
6320 N CENTER DR, BLDG 15 SUITE 201, NORFOLK, VA 23502-4009
(757) 892-5300
(757) 892-5303
Mailing address
6320 N CENTER DR, BLDG 15 SUITE 201, NORFOLK, VA 23502-4009
(757) 892-5300
(757) 892-5303
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
12/02/2013
Last updated
01/10/2014
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