Provider Demographics
NPI:1689974131
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 1:1505 US HIGHWAY 41
Mailing Address - Street 2:UNIT A20
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1321
Mailing Address - Country:US
Mailing Address - Phone:219-322-5560
Mailing Address - Fax:219-322-1549
Practice Address - Street 1:1505 US HIGHWAY 41
Practice Address - Street 2:UNIT A20
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1321
Practice Address - Country:US
Practice Address - Phone:219-322-5560
Practice Address - Fax:219-322-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100038388OtherMEDICARE PTAN
INM100038388OtherMEDICARE PTAN