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General NPI Number Information
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NPI Number | 1285086983
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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 | 07/06/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 21022 S LAGRANGE RD
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City | FRANKFORT
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State | IL
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Zip | 60423-2004
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Country | US
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Telephone | 815-464-1100
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Fax | 815-464-1130
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Provider Business Mailing Address
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Address Line | 625 ENTERPRISE DR
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City | OAK BROOK
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State | IL
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Zip | 60523-8813
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Country | US
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Telephone | 630-575-6200
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Fax | 630-928-5040
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | GERI COOK
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Credential |
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Telephone | 63057519140
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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 | 060-005437
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License Number State | IL
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