Healthcare Provider Details

I. General information

NPI: 1083940274
Provider Name (Legal Business Name): ATHLETICO, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 N DOWNER AVE
MILWAUKEE WI
53211-4245
US

IV. Provider business mailing address

2615 N DOWNER AVE
MILWAUKEE WI
53211-4245
US

V. Phone/Fax

Practice location:
  • Phone: 414-962-4400
  • Fax: 414-662-5674
Mailing address:
  • Phone: 414-962-4400
  • Fax:

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