JACK BOODEN JR. (NPI# 1841319415) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841319415 |
| Entity Type | Individual |
| Full Name | JACK BOODEN JR. |
| Credential | C.P.O. |
| Practice Address |
2418 Granby St Norfolk VA 23517-1422 |
| Practice Telephone | 7576274191 |
| Practice Fax Number | 7576278709 |
| Mailing Telephone | 7576274191 |
| Mailing Fax Number | 7576278709 |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 222Z00000X | Orthotist | CPO 00503 | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | |
| X | 224P00000X | Prosthetist | CPO 00503 | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
2418 GRANBY ST |
| City | NORFOLK |
| State | VA |
| Zip Code | 23517-1422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073593331 | Booden Orthopedic & Prosthetic Center, Inc. | Prosthetic/Orthotic Supplier | 2418 Granby St, Norfolk, VA 23517-1422 | 2006-01-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164948535 | Honey Behavioral Therapy | Behavioral Analyst | 520 W. 21st Street, Suite G2-407, Norfolk, VA 23517 | 2017-08-17 |
| 1245638899 | Americare Plus, LLC. | In Home Supportive Care | 2200 Colonial Avenue, Suite 15, Norfolk, VA 23517 | 2014-12-15 |
| 1932458478 | Carolyn Reed Hersh | Counselor | 117 W. 21st Street, Suite 206, Norfolk, VA 23517 | 2012-08-30 |
| 1487959342 | Harris Teeter, LLC | Pharmacy | 1320 Colonial Avenue, Norfolk, VA 23517 | 2011-01-24 |
| 1912133406 | Air Specialty Corp | Contractor | 121 East 25th St, Norfolk, VA 23517 | 2009-06-10 |
| 1578798849 | East End Academy Inc Southside | Clinic/Center | 2607 Colonial Avenue, Norfolk, VA 23517 | 2009-05-15 |
| 1568682292 | Jennifer S Derugen | Midwife | 1700 Hampton Blvd, Apt A, Norfolk, VA 23517 | 2007-04-26 |
| 1265568026 | Norfolk Integrative Manual Therapy | Physical Therapist | 350 22 St W., Suite 108, Norfolk, VA 23517 | 2007-02-26 |
| 1528133436 | Krysia B Witkowski | Physical Therapist | 350 W 22nd St, Suite 108, Norfolk, VA 23517 | 2006-11-24 |
| 1699846121 | Orthopaedic Associates of Virginia, Ltd | Neuromusculoskeletal Medicine, Sports Medicine | 953b West 21st St, Virginia Beach, VA 23517 | 2006-11-13 |
| Find all providers in zip 23517 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366988578 | Emily Kane | Orthotist | 6320 N Center Dr Ste 201, Norfolk, VA 23502-4009 | 2017-01-11 |
| 1821585787 | Thad Grabowski | Orthotist | 6275 E Virginia Beach Blvd, Norfolk, VA 23502-2851 | 2018-04-17 |
| 1184029399 | Heidi Wagner | Orthotist | 6320 N Center Dr, Bldg #15 Suite 201, Norfolk, VA 23502-4009 | 2014-10-30 |
| 1356772305 | Anna Ellesor Gray Detweiler | Orthotist | 6320 N Center Dr, Bldg 15 Suite 201, Norfolk, VA 23502-4009 | 2013-12-02 |
| 1356667877 | Robert Meade Siverd IIi | Orthotist | 6320 N Center Dr, Bldg #15, Ste #201, Norfolk, VA 23502-4009 | 2010-04-08 |
| 1437107489 | Harry Edmond Bright Jr. | Orthotist | 6320 N Center Dr, Bldg #15 Ste #201, Norfolk, VA 23502 | 2006-05-04 |
| 1245288208 | Steve A Siverd | Orthotist | 6320 N Center Dr, Bldg #15 Ste #201, Norfolk, VA 23502 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639647993 | Madison Vansavage Maben | Orthotist | 433 Network Sta, Chesapeake, VA 23320 | 2018-11-05 |
| 1851883318 | Specialized Orthopaedic Services,inc. | Orthotist | 1951 Evelyn Byrd Ave Ste E, Harrisonburg, VA 22801-3483 | 2018-05-31 |
| 1164887931 | Beth Martin | Orthotist | 2034 Dabney Rd Ste C, Richmond, VA 23230-3361 | 2015-12-22 |
| 1487089124 | Bryan Carroll Fuller | Orthotist | 612 Rio Rd W Ste 5, Charlottesville, VA 22901-1412 | 2013-09-12 |
| 1215361886 | Michael L. Butts | Orthotist | Dept of Veterans Affairs Hunter Holmes Ctr, 1201 Broad Rock Blvd, Richmond, VA 23249-0001 | 2013-08-30 |
| 1447592936 | Joseph L. Lawson | Orthotist | 1135 First Colonial Rd, Virginia Beach, VA 23454-2402 | 2013-03-22 |
| 1851631105 | Booden Orthopedic & Prosthetic Center Inc | Orthotist | 5511 Princess Anne Rd, Suite 101, Virginia Beach, VA 23462-3321 | 2013-02-25 |
| 1487905378 | Ksenia Noelle Major | Orthotist | 2139 Staples Mill Rd, Richmond, VA 23230-2905 | 2012-10-02 |
| 1780982660 | Carter P Williams | Orthotist | 1500 Huguenot Rd, Suite 106, Midlothian, VA 23113-2478 | 2011-03-02 |
| 1427284538 | Sarah A Lane | Orthotist | 1726 Amherst St Ste 600, Winchester, VA 22601-2807 | 2009-06-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.