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NPI Code Detail

MEDICARE: MR. RONALD FRANK AGRIGENTO P.T., A.T.C.

MEDICARE: MR. RONALD FRANK AGRIGENTO P.T., A.T.C.
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
1225100000XPhysical TherapistIL

General Provider Information

NPI Number : 1376658161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD FRANK AGRIGENTO P.T., A.T.C.
Provider Business Mailing Address
First Line : 18465 COWING CT
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-3334
Country : US
Telephone Number : 708-206-0584
Fax Number : 708-206-1587
Provider Business Practice Location Address
First Line : 13114 WESTERN AVE
Second Line :
City : BLUE ISLAND
State : IL
Zip : 60406-2439
Country : US
Telephone Number : 708-824-0515
Fax Number : 708-824-0516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 07/08/2007

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