Provider Demographics
NPI:1144428095
Name:RAVETTO, THOMAS B (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:B
Last Name:RAVETTO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19930 S JESSICA LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9270
Mailing Address - Country:US
Mailing Address - Phone:815-464-9308
Mailing Address - Fax:
Practice Address - Street 1:19525 FORESTDALE CT
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8261
Practice Address - Country:US
Practice Address - Phone:708-478-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics