Athletico Ltd

NPI #1558964924 in Columbia, Illinois

Provider Information

NPI Number: 1558964924
Entity Type: Organization
Organization Name: Athletico Ltd
Primary Specialty: Clinic/Center
Enumeration Date: Nov 18, 2020
Last Updated: Nov 18, 2020

Practice Location

Address: 1050 ADMIRAL WEINEL BLVD
City: Columbia
State: Illinois
ZIP Code: 62236-1988
Phone: (618) 693-3100

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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