Organization · NPI-2

Athletico Ltd

Clinic/Center · Grand Rapids, MI

NPI number1477087617
StatusActive
Last updated in NPPESMar 9, 2020

Details

NPI
1477087617
Entity type
Organization (NPI-2)
Legal business name
Athletico Ltd
Organization subpart
No
Enumeration date
Apr 14, 2017
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

6333 Kalamazoo Ave Se
Ste 600
Grand Rapids, MI 49508-7890

Phone 616-649-1577 · Fax 616-710-3019

Mailing address

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

Phone 630-575-1980 · Fax 630-928-5080

Authorized official

Juana Granados
Credentialing Manager
6305751980

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