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		IL

General Provider Information

NPI Number	:	1063883494
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	:	3922 NORTH SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613
Country	:	US
Telephone Number	:	773-327-0040
Fax Number	:	773-327-0050

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	GERI COOK
Credential	:
Telephone Number	:	630-575-1940

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	08/22/2017

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Directions to “ATHLETICO, LTD ” Practice Location

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