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General NPI Number Information
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NPI Number | 1366109852
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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 | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 1519 W SOUTH ST STE 300
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City | LEBANON
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State | IN
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Zip | 46052-2371
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Country | US
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Telephone | 765-335-3355
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Fax | 765-485-9073
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-1980
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Fax | 630-928-5080
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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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