MEDICARE: MAY RICAFORT

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	15513	NC

General Provider Information

NPI Number	:	1134506835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAY RICAFORT

Provider Business Mailing Address
First Line	:	1737 NASHVILLE LANE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014
Country	:	US
Telephone Number	:	815-271-2845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 NASHVILLE LN
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-2916
Country	:	US
Telephone Number	:	815-271-2845
Fax Number	:

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

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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Directions to “ MAY RICAFORT ” Practice Location

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