Healthcare Provider Details

I. General information

NPI: 1083941330
Provider Name (Legal Business Name): MARCELA LOTERO SWETLAND PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCELA LOTERO GIRALDO PT

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 W GRAND RIVER AVE STE 600
BRIGHTON MI
48116-4359
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-1187
  • Fax: 810-225-1284
Mailing address:
  • Phone: 630-575-6200
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031971
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501017104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: