Basic Information
| Provider Information | |||||||||
| NPI: | 1780978932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATHLETICO, LTD | ||||||||
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| OtherOrganizationName: | ATHLETICO PHYSICAL THERAPY & OCCUPATIONAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6347 CERMAK RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604024200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087492566 | ||||||||
| FaxNumber: | 7087492498 | ||||||||
| Practice Location | |||||||||
| Address1: | 6347 CERMAK RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604024200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087492566 | ||||||||
| FaxNumber: | 7087492498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2011 | ||||||||
| LastUpdateDate: | 06/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | GERI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CLINICAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6305751940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.