MEDICARE: ATHLETICO LTD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1477210128
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	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	12345 ALTA VISTA RD STE 113
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6436
Country	:	US
Telephone Number	:	682-593-2550
Fax Number	:	682-582-8641

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

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/17/2021

Similar Medicare Providers

1043148265 — SAMANTHA DAPKIEWICZ PT, DPT
Practice Location Address:

12345 ALTA VISTA RD STE 113
FORT WORTH, TX
76244-6436

Practice Phone: 682-593-2550
Practice Fax:

1760107809 — JONATHON SNOW
Practice Location Address:

12345 ALTA VISTA RD STE 113
FORT WORTH, TX
76244-6436

Practice Phone: 682-593-2550
Practice Fax:

1306670864 — ANGELA VIZCAINO DPT
Practice Location Address:

12345 ALTA VISTA RD STE 113
FORT WORTH, TX
76244-6436

Practice Phone: 682-593-2550
Practice Fax:

1689532665 — DESHONDA CHARTRICE TUCKER
Practice Location Address:

6436 BRENTWOOD STAIR RD
FORT WORTH, TX
76112-3228

Practice Phone: 682-351-7748
Practice Fax:

1780092551 — CARING HEARTS AHS INC
Practice Location Address:

5720 FEARNLEY RD
LAKE WORTH, FL
33467-6436

Practice Phone: 561-507-5059
Practice Fax: 561-507-5059

1588731962 — ADVANCED CHIROPRACTIC CLINIC, P.A.
Practice Location Address:

1808 SECOND BAXTER XING , SUITE 108
FORT MILL, SC
29708-6436

Practice Phone: 803-802-2225
Practice Fax: 803-802-2275

Directions to “ATHLETICO LTD ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.