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General NPI Number Information
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NPI Number | 1386358885
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Entity Type | Organization
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Legal Business Name | DIFFERENT APPROACH WELLNESS CENTER
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 20905 GREENFIELD RD STE 701M
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5356
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Country | US
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Telephone | 313-536-3040
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Fax | 313-536-3041
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Provider Business Mailing Address
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Address Line | 20905 GREENFIELD RD STE 701M
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5356
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Country | US
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Telephone | 313-536-3040
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Fax | 313-536-3041
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Authorized Official
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Title or Position | NP/OWNER
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Name | THERA TERRES RADNEY
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Credential | NP
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Telephone | 313-536-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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