Provider Demographics
NPI:1376658161
Name:AGRIGENTO, RONALD FRANK (PT, ATC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:FRANK
Last Name:AGRIGENTO
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18465 COWING CT
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3334
Mailing Address - Country:US
Mailing Address - Phone:708-206-0584
Mailing Address - Fax:708-206-1587
Practice Address - Street 1:13114 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2439
Practice Address - Country:US
Practice Address - Phone:708-824-0515
Practice Address - Fax:708-824-0516
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
548730Medicare ID - Type Unspecified