Organization · NPI-2

Athletico Ltd

Clinic/Center · Florissant, MO

NPI number1730782111
StatusActive
Last updated in NPPESNov 18, 2020

Details

NPI
1730782111
Entity type
Organization (NPI-2)
Legal business name
Athletico Ltd
Organization subpart
No
Enumeration date
Nov 18, 2020
Certification date
Nov 18, 2020
Last updated
Nov 18, 2020

Taxonomy and licenses

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

Other names

  • Athletico Physical Therapy (Doing Business As)

Practice location

790 N Highway 67 St
Florissant, MO 63031-5108

Phone 314-972-1442 · Fax 314-972-1533

Mailing address

600 Oakmont Ln Ste 600c
Westmont, IL 60559-5548

Phone 630-575-6250 · Fax 630-575-7450

Authorized official

Juana Granados
Credentialing Manager
6305751980

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