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

General Provider Information

NPI Number	:	1982810347
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	:	630-575-6250
Fax Number	:	630-575-7450

Provider Business Practice Location Address
First Line	:	500 N KINGSBURY ST
Second Line	:	EAST BANK CLUB
City	:	CHICAGO
State	:	IL
Zip	:	60610-4021
Country	:	US
Telephone Number	:	312-527-5801
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2017

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