Provider Demographics
NPI:1194334003
Name:RICOBENE, VINCENT (PT, DPT)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:RICOBENE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16931 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7206
Mailing Address - Country:US
Mailing Address - Phone:708-262-0686
Mailing Address - Fax:
Practice Address - Street 1:6625 W LINCOLN HWY LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9678
Practice Address - Country:US
Practice Address - Phone:219-440-5360
Practice Address - Fax:219-440-5361
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013113A225100000X
IL070.023033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist