Healthcare Provider Details

I. General information

NPI: 1700270717
Provider Name (Legal Business Name): ATHLETICO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 75TH ST
WILLOWBROOK IL
60527-2366
US

IV. Provider business mailing address

329 75TH ST
WILLOWBROOK IL
60527-2366
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-0004
  • Fax: 630-789-0095
Mailing address:
  • Phone: 630-789-0004
  • Fax: 630-789-0095

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