Provider Demographics
NPI:1790289841
Name:TETER ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:TETER ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUMFLEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-947-5701
Mailing Address - Street 1:1225 W FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1323
Mailing Address - Country:US
Mailing Address - Phone:231-947-5701
Mailing Address - Fax:231-947-1370
Practice Address - Street 1:977 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-9800
Practice Address - Country:US
Practice Address - Phone:231-924-6301
Practice Address - Fax:616-949-4051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TETER ORTHOTICS & PROSTHETICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-22
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier