Active NPI
Athletico LTD
Doing business as Athletico Physical Therapy
- Clinic/Center
- Southlake, TX
National Provider Identifier
1225608359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- ATHLETICO LTD
- Doing business as
- Athletico Physical Therapy
- Practice address
- 480 W Southlake Blvd Ste 111
Southlake, TX 76092-6167 - Phone
- (817) 778-9910
- Fax
- (817) 203-0337
- NPI assigned
- Jun 30, 2021
- Last updated
- Jun 30, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Juana Granados
- Title
- Credentialing Manager
- Phone
- (630) 575-1980
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | ||
| Occupational Therapist | 225X00000X | NU | ||
| Clinic/Center | 261Q00000X | NU | Primary |
Addresses
Primary practice location
480 W Southlake Blvd Ste 111
Southlake, TX 76092-6167
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6250
Other names 1
- Athletico Physical Therapy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230612002579 | TX | DME Supplier - Independently-Practicing Physical Therapist | 4789602681 | Practice locations: Southlake, TX |
National Provider Directory
National Provider Directory- Tax ID family
- Athletico Physical Therapy
Organizations with this tax ID in the same state 18
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625011200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1625011200000",
"number": "1225608359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2122 YORK RD STE 300",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605231925",
"telephone_number": "630-575-6250",
"fax_number": "630-575-7450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 W SOUTHLAKE BLVD STE 111",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926167",
"telephone_number": "817-778-9910",
"fax_number": "817-203-0337"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ATHLETICO LTD",
"organizational_subpart": "NO",
"enumeration_date": "2021-06-30",
"last_updated": "2021-06-30",
"certification_date": "2021-06-30",
"status": "A",
"authorized_official_last_name": "GRANADOS",
"authorized_official_first_name": "JUANA",
"authorized_official_title_or_position": "CREDENTIALING MANAGER",
"authorized_official_telephone_number": "630-575-1980"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Athletico Physical Therapy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.