Healthcare Provider Details

I. General information

NPI: 1164349627
Provider Name (Legal Business Name): RYAN RICCITELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 OGDEN AVE STE 1026
DOWNERS GROVE IL
60515-2812
US

IV. Provider business mailing address

1426 FOXHILL RD
NAPERVILLE IL
60563-2103
US

V. Phone/Fax

Practice location:
  • Phone: 630-856-7600
  • Fax:
Mailing address:
  • Phone: 630-940-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number160.009839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: