Healthcare Provider Details

I. General information

NPI: 1710122361
Provider Name (Legal Business Name): ATHLETICO, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3644 W. 111TH STREET
CHICAGO IL
60655
US

IV. Provider business mailing address

625 ENTERPRISE DR.
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 773-779-8480
  • Fax: 773-779-8404
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: GERI COOK
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential:
Phone: 630-575-1940