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	:	1588244222
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	:	630-575-7450

Provider Business Practice Location Address
First Line	:	1201 ELM ST STE 121
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75270-2014
Country	:	US
Telephone Number	:	469-620-5070
Fax Number	:	469-983-1972

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

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “ATHLETICO LTD ” Practice Location

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