Provider Demographics
NPI:1497643878
Name:RICAFRENTE, JORJETTE WILLY
Entity type:Individual
Prefix:
First Name:JORJETTE
Middle Name:WILLY
Last Name:RICAFRENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 N ODELL AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2936
Mailing Address - Country:US
Mailing Address - Phone:224-628-6226
Mailing Address - Fax:
Practice Address - Street 1:7370 W TALCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3751
Practice Address - Country:US
Practice Address - Phone:773-594-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.029087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist