Athletico Excel Nebraska, LLC

NPI #1346740800 in Elkhorn, Nebraska

Provider Information

NPI Number: 1346740800
Entity Type: Organization
Organization Name: Athletico Excel Nebraska, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Feb 20, 2018
Last Updated: Feb 20, 2018

Practice Location

Address: 1303 S 204TH ST
City: Elkhorn
State: Nebraska
ZIP Code: 68022-2880
Phone: (402) 933-9111

Authorized Official

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

Specialties & Taxonomy Codes

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

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