# ATHLETICO LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ATHLETICO PHYSICAL THERAPY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366792350
- **Authorized official:** JUANA GRANADOS (CREDENTIALING MANAGER)
- **Authorized official phone:** (630) 575-1980

## Contact information

- **Practice address:** 5708 75TH ST UNIT B, KENOSHA, WI 53142-3635
- **Practice address phone:** (262) 697-9135
- **Practice address fax:** (262) 697-9175
- **Mailing address:** 5708 75TH ST, KENOSHA, WI 53142-3635
- **Mailing address phone:** (262) 697-9135
- **Mailing address fax:** (262) 697-9175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | IL | Yes |

## Other

- **Enumeration date:** 09/17/2012
- **Last updated:** 10/27/2021