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General NPI Number Information
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NPI Number | 1235732603
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Entity Type | Organization
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Legal Business Name | ATHLETICO LTD
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 2900 TRIMBLE RD STE 101
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City | COLUMBIA
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State | MO
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Zip | 65201-7180
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Country | US
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Telephone | 573-397-7036
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Fax | 573-734-0730
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Provider Business Mailing Address
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Address Line | 600 OAKMONT LN STE 600C
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City | WESTMONT
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State | IL
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Zip | 60559-5548
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Country | US
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Telephone | 630-575-6250
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Fax | 630-575-7450
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JUANA GRANADOS
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Credential |
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Telephone | 630-575-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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