Organization · NPI-2

Athletico Ltd

Clinic/Center · Fort Wayne, IN

NPI number1154081040
StatusActive
Last updated in NPPESDec 20, 2021

Details

NPI
1154081040
Entity type
Organization (NPI-2)
Legal business name
Athletico Ltd
Organization subpart
No
Enumeration date
Dec 20, 2021
Certification date
Dec 20, 2021
Last updated
Dec 20, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes
225100000X Physical Therapist––
225X00000X Occupational Therapist––

Other names

  • Athletico Physical Therapy (Doing Business As)

Practice location

4826 Illinois Rd
Fort Wayne, IN 46804-1166

Phone 260-209-1340 · Fax 260-247-7112

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925

Phone 630-575-1980 · Fax 630-928-5080

Authorized official

Juana Granados
Credentialing Manager
6305751980

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Clinic/Center providers in Fort Wayne, IN