Athletico Ltd

NPI #1679041396 in Gladstone, Missouri

Provider Information

NPI Number: 1679041396
Entity Type: Organization
Organization Name: Athletico Ltd
Primary Specialty: Clinic/Center
Enumeration Date: Nov 12, 2018
Last Updated: Nov 12, 2018

Practice Location

Address: 6403 N PROSPECT AVE # 450
City: Gladstone
State: Missouri
ZIP Code: 64119-1545
Phone: (816) 656-3698

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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