{
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"OrgName": "ATHLETICO LTD",
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"NamePrefix": null,
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"FirstLineMailingAddress": "625 ENTERPRISE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAK BROOK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60523-8813",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-575-6250",
"MailingAddressFaxNumber": "630-575-7450",
"FirstLinePracticeLocationAddress": "5328 MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE 122",
"PracticeLocationAddressCityName": "LISLE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60532-4185",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-343-5093",
"PracticeLocationAddressFaxNumber": "630-343-5095",
"EnumerationDate": "05/16/2007",
"LastUpdateDate": "03/08/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COOK",
"AuthorizedOfficialFirstName": "GERI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF CLINICAL SERVICES",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "630-575-1940",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "060005437",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}