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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
2261Q00000XClinic/Center
3225X00000XOccupational Therapist

General Provider Information

NPI Number : 1457295693
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 : 211 E SUNSET DR
Second Line :
City : WAUKESHA
State : WI
Zip : 53189-7603
Country : US
Telephone Number : 262-832-7600
Fax Number : 262-832-7601
Authorized Official
Title or Position : DIRECTOR, CREDENTIALING
Name : JUANA GRANADOS
Credential :
Telephone Number : 630-575-1980
Provider Enumeration Date : 04/17/2026
Last Update Date : 04/17/2026

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Directions to “ATHLETICO LTD ” Practice Location

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