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General NPI Number Information
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NPI Number | 1760698120
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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 | 05/15/2007
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 1323 W DIVERSEY PKWY
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City | CHICAGO
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State | IL
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Zip | 60614-1207
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Country | US
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Telephone | 773-549-2520
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Fax |
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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 | 630-575-6250
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Fax | 630-575-7450
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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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