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General NPI Number Information
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NPI Number | 1144428095
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Entity Type | Individual
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Provider Name | THOMAS B RAVETTO PT
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19525 FORESTDALE CT
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City | MOKENA
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State | IL
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Zip | 60448-8261
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Country | US
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Telephone | 708-478-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 19930 S JESSICA LN
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City | FRANKFORT
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State | IL
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Zip | 60423-9270
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Country | US
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Telephone | 815-464-9308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | IL
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