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		IL

General Provider Information

NPI Number	:	1912337791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETICO LTD

Provider Business Mailing Address
First Line	:	113 S EASTWOOD DR
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3519
Country	:	US
Telephone Number	:	815-334-0400
Fax Number	:	815-334-0800

Provider Business Practice Location Address
First Line	:	113 S EASTWOOD DR
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3519
Country	:	US
Telephone Number	:	815-334-0400
Fax Number	:	815-334-0800

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	GERI COOK
Credential	:
Telephone Number	:	630-575-1940

Provider Enumeration Date	:	11/15/2013
Last Update Date	:	11/15/2013

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Directions to “ATHLETICO LTD ” Practice Location

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