MEDICARE: ATHLETICO LTD

Medicare Provider Information

Scope of Practice

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

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

General Provider Information

NPI Number	:	1487303335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETICO LTD

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	51242 ROMEO PLANK RD
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-4129
Country	:	US
Telephone Number	:	586-265-2520
Fax Number	:	586-238-3722

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

Provider Enumeration Date	:	03/19/2022
Last Update Date	:	03/19/2022

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Directions to “ATHLETICO LTD ” Practice Location

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