Individual
THERESA WITHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PROSTHETICS
Contact information
Practice address
11779 MAIDEN ST, DETROIT, MI 48213-1605
(586) 900-1707
Mailing address
11779 MAIDEN ST, DETROIT, MI 48213-1605
(586) 900-1707
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
MI
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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