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Organization
ATHLETICO LTD
Active
Organization
ATHLETICO LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANA GRANADOS (CREDENTIALING MANAGER)
(630) 575-1980
Entity
Organization
Contact information
Practice address
1504 E SUMNER ST, HARTFORD, WI 53027-2607
(262) 709-8466
(262) 216-1979
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/18/2022
Last updated
07/18/2022
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