Organization · NPI-2

Athletico Ltd

Clinic/Center · Southfield, MI

NPI number1881129757
StatusActive
Last updated in NPPESMar 9, 2020

Details

NPI
1881129757
Entity type
Organization (NPI-2)
Legal business name
Athletico Ltd
Organization subpart
No
Enumeration date
Apr 27, 2017
Certification date
Mar 9, 2020
Last updated
Mar 9, 2020

Taxonomy and licenses

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

Other names

  • Athletico Physical Therapy (Doing Business As)

Practice location

26571 Evergreen Rd
Southfield, MI 48076-4201

Phone 248-639-4804

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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