Athletico LTD
Organization Active NPI Clinic/Center · Lewisville, TX
NPI 1902540933 · NPPES record last updated Apr 26, 2022
Key facts
- NPI
- 1902540933
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- ATHLETICO LTD
- Practice address
- 4770 State Highway 121 Ste 130
Lewisville, TX 75056-2913 - Phone
- (469) 830-9030
- Fax
- (469) 390-0010
- NPI assigned
- Apr 26, 2022
- Organization subpart
- No
Authorized official
- Name
- Juana Granados
- Title
- Credentialing Manager
- Phone
- (630) 575-1980
Corporate family (same tax ID) 15
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220812001394 | TX | DME Supplier - Independently-Practicing Physical Therapist |
4789602681 | Practice locations: Lewisville, TX |
National Provider Directory
- Tax ID family
- Athleticoltd
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X | |||
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
4770 State Highway 121 Ste 130
Lewisville, TX 75056-2913
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Other names
- Athletico Physical Therapy
Other providers in Lewisville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.