=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750247466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRYS WIGS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2025
-----------------------------------------------------
Last Update Date | 12/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19139 LIVERNOIS AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48221-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-863-4014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19139 LIVERNOIS AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48221-1715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-863-4014
-----------------------------------------------------
Fax | 313-863-4014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. LAWRENCE XAVIER LANIER SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-732-8512
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------