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NPI Code Detail

MEDICARE: ATHLETICO LTD

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
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3261Q00000XClinic/Center

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WI1760OTHERWIMEDICARE PTAN

General Provider Information

NPI Number : 1083940274
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 : 630-575-6200
Fax Number :
Provider Business Practice Location Address
First Line : 2615 N DOWNER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-4245
Country : US
Telephone Number : 414-962-4400
Fax Number : 414-662-5674
Authorized Official
Title or Position : DIRECTOR, CREDENTIALING
Name : JUANA GRANADOS
Credential :
Telephone Number : 630-575-1980
Provider Enumeration Date : 10/23/2009
Last Update Date : 04/17/2026

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Directions to “ATHLETICO LTD ” Practice Location

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