Healthcare Provider Details

I. General information

NPI: 1689974131
Provider Name (Legal Business Name): ATHLETICO, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 US HIGHWAY 41 UNIT A20
SCHERERVILLE IN
46375-1321
US

IV. Provider business mailing address

1505 US HIGHWAY 41 UNIT A20
SCHERERVILLE IN
46375-1321
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-5560
  • Fax: 219-322-1549
Mailing address:
  • Phone: 219-322-5560
  • Fax: 219-322-1549

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