# ATHLETICO LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Athletico Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053195990
- **Authorized official:** JUANA GRANADOS (CREDENTIALING MANAGER)
- **Authorized official phone:** (630) 575-1980

## Contact information

- **Practice address:** 2205 JEFFERSON DAVIS DR, OXFORD, MS 38655-5221
- **Practice address phone:** (662) 238-2800
- **Practice address fax:** (662) 238-2808
- **Mailing address:** 2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
- **Mailing address phone:** (630) 575-1980
- **Mailing address fax:** (630) 928-5080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/22/2023
- **Last updated:** 08/22/2023