Healthcare Provider Details

I. General information

NPI: 1235656760
Provider Name (Legal Business Name): ATHLETICO, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 W WEBSTER AVE # 4
CHICAGO IL
60614-3049
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-3100
  • Fax: 773-871-7388
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number060-005437
License Number StateIL

VIII. Authorized Official

Name: GERI COOK
Title or Position: VP OF OPERATIONS
Credential:
Phone: 630-575-1940