MEDICARE: ATHLETICO LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1386136836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETICO LTD

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:	630-928-5080

Provider Business Practice Location Address
First Line	:	49443 VAN DYKE AVE
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-1310
Country	:	US
Telephone Number	:	586-580-8460
Fax Number	:	586-210-9626

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JUANA GRANADOS
Credential	:
Telephone Number	:	630-575-1980

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	03/09/2020

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Directions to “ATHLETICO LTD ” Practice Location

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