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	060-005437	IL

General Provider Information

NPI Number	:	1386091395
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	:	630-575-6200
Fax Number	:	630-928-5040

Provider Business Practice Location Address
First Line	:	834 N ELMHURST RD
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1132
Country	:	US
Telephone Number	:	847-215-7200
Fax Number	:	847-215-7900

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	GERI COOK
Credential	:
Telephone Number	:	63057519140

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	10/27/2016

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Directions to “ATHLETICO LTD. ” Practice Location

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