Athletico LTD
Organization Active NPI Clinic/Center · South Lyon, MI
NPI 1992401574 · NPPES record last updated Feb 6, 2023
Key facts
- NPI
- 1992401574
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- ATHLETICO LTD
- Practice address
- 22179 Pontiac TRL Ste C
South Lyon, MI 48178-1638 - Phone
- (248) 587-7843
- Fax
- (248) 782-3490
- NPI assigned
- Feb 6, 2023
- Organization subpart
- No
Authorized official
- Name
- Juana Granados
- Title
- Credentialing Manager
- Phone
- (630) 575-1980
Corporate family (same tax ID) 12
Member of 1
National Provider Directory
- Tax ID family
- Athleticoltd
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | |||
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
22179 Pontiac TRL Ste C
South Lyon, MI 48178-1638
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6250
Other providers in South Lyon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.