| Athletico Ltd | |
|
655 Kenmoor Ave Se Ste 103 Grand Rapids MI 49546-8622 | |
| (616) 315-0100 | |
| (614) 410-7790 |
| Full Name | Athletico Ltd |
|---|---|
| Speciality | Clinic/center |
| Location | 655 Kenmoor Ave Se Ste 103, Grand Rapids, Michigan |
| Authorized Official Name and Position | Juana Granados (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6305751980 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Athletico Ltd 2122 York Rd Ste 300 Oak Brook IL 60523-1925 Ph: (630) 575-6200 | Athletico Ltd 655 Kenmoor Ave Se Ste 103 Grand Rapids MI 49546-8622 Ph: (616) 315-0100 |
| NPI Number | 1801513973 |
|---|---|
| Provider Enumeration Date | 10/20/2022 |
| Last Update Date | 10/20/2022 |
| Certification Date | 10/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801513973 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 225100000X | Physical Therapist | (NU) | Secondary |
| 225X00000X | Occupational Therapist | (NU) | Secondary |
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