Organization
ATHLETICO LTD
Active
Organization
ATHLETICO LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON (CREDENTIALING MANAGER)
(252) 248-3313
Entity
Organization
Contact information
Practice address
957 S ROCHESTER RD, ROCHESTER HILLS, MI 48307
(248) 963-0502
(248) 963-1072
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(630) 575-1980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/13/2024
Last updated
03/13/2024
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