MEDICARE: VINCENT RICOBENE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05013113A	IN
2	225100000X	Physical Therapist	070.023033	IL

General Provider Information

NPI Number	:	1194334003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT RICOBENE PT, DPT

Provider Business Mailing Address
First Line	:	16931 89TH AVE
Second Line	:
City	:	ORLAND HILLS
State	:	IL
Zip	:	60487-7206
Country	:	US
Telephone Number	:	708-262-0686
Fax Number	:

Provider Business Practice Location Address
First Line	:	6625 W LINCOLN HWY LOWR LEVEL
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9678
Country	:	US
Telephone Number	:	219-440-5360
Fax Number	:	219-440-5361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	08/18/2020

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