MEDICARE: ATHLETICO LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1013733286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETICO LTD

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	252-248-3313
Fax Number	:	410-678-4878

Provider Business Practice Location Address
First Line	:	6511 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3042
Country	:	US
Telephone Number	:	502-795-1770
Fax Number	:	502-537-6177

Authorized Official
Title or Position	:	MANAGER, CREDENTIALING
Name	:	TASHEDA BROUGHTON
Credential	:	PESC
Telephone Number	:	252-248-3313

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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Directions to “ATHLETICO LTD ” Practice Location

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