Organization · NPI-2

Athletico Ltd

Clinic/Center · Grand Rapids, MI

NPI number1205289519
StatusActive
Last updated in NPPESMar 9, 2020

Details

NPI
1205289519
Entity type
Organization (NPI-2)
Legal business name
Athletico Ltd
Organization subpart
No
Enumeration date
Jul 21, 2016
Certification date
Mar 9, 2020
Last updated
Mar 9, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes
225100000X Physical Therapist––
225X00000X Occupational Therapist––

Other names

  • Athletico Physical Therapy (Doing Business As)

Practice location

1600 E Beltline Ave Ne
Suite 301
Grand Rapids, MI 49525-7024

Phone 616-818-0586 · Fax 616-818-0587

Mailing address

600 Oakmont Ln Ste 600c
Westmont, IL 60559-5548

Phone 630-575-6250 · Fax 630-575-7450

Authorized official

Juana Granados
Credentialing Manager
6305751980

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Clinic/Center providers in Grand Rapids, MI