Healthcare Provider Details

I. General information

NPI: 1669859831
Provider Name (Legal Business Name): ATHLETICO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 PRINCETON DR UNIT A
HUNTLEY IL
60142-7655
US

IV. Provider business mailing address

12360 PRINCETON DR UNIT A
HUNTLEY IL
60142-7655
US

V. Phone/Fax

Practice location:
  • Phone: 847-961-5500
  • Fax: 847-961-5580
Mailing address:
  • Phone: 847-961-5500
  • Fax: 847-961-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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