# SPORTS PHYSICAL THERAPY & REHAB SPECIALIST SC

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

## Provider details

- **NPI number:** 1417455528
- **Authorized official:** JUANA GRANADOS (CREDENTIALING MANAGER)
- **Authorized official phone:** (630) 575-1980

## Contact information

- **Practice address:** 1201 MAIN ST, UNION GROVE, WI 53182-1303
- **Practice address phone:** (262) 878-9602
- **Practice address fax:** (262) 878-9609
- **Mailing address:** 600 OAKMONT LN, WESTMONT, IL 60559-5548
- **Mailing address phone:** (630) 575-1980
- **Mailing address fax:** (630) 928-5080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | IL | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/24/2018
- **Last updated:** 04/06/2018