Provider Demographics
NPI:1578965703
Name:ATHLETICO, LTD
Entity Type:Organization
Organization Name:ATHLETICO, LTD
Other - Org Name:ATHLETICO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-575-1940
Mailing Address - Street 1:11780 OLIO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7616
Mailing Address - Country:US
Mailing Address - Phone:317-594-1800
Mailing Address - Fax:317-594-8500
Practice Address - Street 1:11780 OLIO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7616
Practice Address - Country:US
Practice Address - Phone:317-594-1800
Practice Address - Fax:317-594-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty