Athletico Ltd

NPI #1063914638 in Wauwatosa, Wisconsin

Provider Information

NPI Number: 1063914638
Entity Type: Organization
Organization Name: Athletico Ltd
Primary Specialty: Clinic/Center
Enumeration Date: Feb 28, 2018
Last Updated: Oct 1, 2018

Practice Location

Address: 3077 N MAYFAIR RD STE 105
City: Wauwatosa
State: Wisconsin
ZIP Code: 53222-4305
Phone: (414) 455-5797

Authorized Official

Name: JUANA GRANADOS
Title: CREDENTIALING MANAGER
Phone: (630) 575-1980

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X
Occupational Therapist	225X00000X
Clinic/Center	261Q00000X	Primary

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