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General NPI Number Information
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NPI Number | 1750650081
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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 | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 852 GREEN BAY RD
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City | WINNETKA
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State | IL
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Zip | 60093-1853
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Country | US
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Telephone | 847-441-5788
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Fax | 847-784-8720
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Provider Business Mailing Address
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Address Line | 852 GREEN BAY RD
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City | WINNETKA
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State | IL
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Zip | 60093-1853
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Country | US
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Telephone | 847-441-5788
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Fax | 847-784-8720
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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 |
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License Number State | IL
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