Athletico Ltd

NPI #1902409386 in Fenton, Missouri

Provider Information

NPI Number: 1902409386
Entity Type: Organization
Organization Name: Athletico Ltd
Primary Specialty: Clinic/Center
Enumeration Date: Nov 18, 2020
Last Updated: Nov 18, 2020

Practice Location

Address: 784 GRAVOIS BLUFFS BLVD
City: Fenton
State: Missouri
ZIP Code: 63026-7726
Phone: (636) 349-8060

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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