Provider Demographics
NPI:1689334146
Name:WITHERS, BRITTANI DAWN
Entity Type:Individual
Prefix:
First Name:BRITTANI
Middle Name:DAWN
Last Name:WITHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4559 ISABELLA
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-8701
Mailing Address - Country:US
Mailing Address - Phone:304-544-7667
Mailing Address - Fax:
Practice Address - Street 1:4559 ISABELLA
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-8701
Practice Address - Country:US
Practice Address - Phone:304-544-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502007940225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant