Healthcare Provider Details

I. General information

NPI: 1083034334
Provider Name (Legal Business Name): MARTINA GRACE RICAFORT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 HAMMILL LN
RENO NV
89511-1004
US

IV. Provider business mailing address

9410 PROTOTYPE DR STE 7
RENO NV
89521-5903
US

V. Phone/Fax

Practice location:
  • Phone: 775-502-4616
  • Fax:
Mailing address:
  • Phone: 240-469-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5028
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23250
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: