Individual
DIVINE MATHES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5101 JOHN C LODGE FWY, DETROIT, MI 48202-3327
(313) 577-4280
Mailing address
23010 HAYES AVE, EASTPOINTE, MI 48021-1541
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601002776
MI
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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