Healthcare Provider Details

I. General information

NPI: 1487860201
Provider Name (Legal Business Name): ATHLETICO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 N HARLEM AVE
OAK PARK IL
60302-1529
US

IV. Provider business mailing address

600 OAKMONT LN # 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-2086
  • Fax: 708-386-3028
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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