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General NPI Number Information
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NPI Number | 1598216293
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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 | 10/18/2016
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Last Update Date | 08/24/2017
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Provider Practice Location Address
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Address Line | 11810 S. MARSHFIELD AVE.
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 773-360-0545
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Fax | 773-360-5482
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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 | 630-575-1940
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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 | 630-575-1940
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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 | 060005437
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License Number State | IL
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