Provider Demographics
NPI:1821085028
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:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANADOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-575-1980
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:2122 YORK RD STE 300
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1925
Practice Address - Country:US
Practice Address - Phone:630-575-1980
Practice Address - Fax:630-928-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001618843OtherBLUE CROSS BLUE SHIELD
ILPTAN DT3853OtherMEDICARE RAIROAD
ILIL7250Medicare Oscar/Certification
ILIL7248Medicare Oscar/Certification
ILIL7249Medicare Oscar/Certification