Provider Demographics
NPI:1770857195
Name:ATHLETEPT, LLC
Entity Type:Organization
Organization Name:ATHLETEPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:952-322-7383
Mailing Address - Street 1:7210 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3513
Mailing Address - Country:US
Mailing Address - Phone:952-322-7383
Mailing Address - Fax:
Practice Address - Street 1:7210 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3513
Practice Address - Country:US
Practice Address - Phone:952-322-7383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty