MEDICARE: ATHLETICO, LTD.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	060005437	IL

General Provider Information

NPI Number	:	1023520244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETICO, LTD.

Provider Business Mailing Address
First Line	:	625 ENTERPRISE DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-8813
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	5601 W MONEE MANHATTAN RD STE 115
Second Line	:
City	:	MONEE
State	:	IL
Zip	:	60449-8866
Country	:	US
Telephone Number	:	708-314-7761
Fax Number	:	708-314-7762

Authorized Official
Title or Position	:	CREDENTTIALING MANAGER
Name	:	JUANA GRANADOS
Credential	:
Telephone Number	:	630-575-1980

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	10/27/2017

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Directions to “ATHLETICO, LTD. ” Practice Location

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