Organization
EXTENSION COUTURE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARMAINE BRYANT (CEO)
(313) 205-9545
Entity
Organization
Contact information
Practice address
17600 W 8 MILE RD, SOUTHFIELD, MI 48075-4305
(248) 973-7340
Mailing address
PO BOX 39706, REDFORD, MI 48239-0706
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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