Athletico Ltd

NPI #1295393056 in Raymore, Missouri

Provider Information

NPI Number: 1295393056
Entity Type: Organization
Organization Name: Athletico Ltd
Primary Specialty: Clinic/Center
Enumeration Date: Jun 5, 2019
Last Updated: Jun 5, 2019

Practice Location

Address: 2007 W FOXWOOD DRIVE
Address 2: SUITE D
City: Raymore
State: Missouri
ZIP Code: 64083-9589
Phone: (816) 265-8116

Authorized Official

Name: JUANA GRANADOS
Title: CREDENTIALING COORDINATOR
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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