Physical Therapy of Mystic, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

003770 Issued in CT

Legal business name

PHYSICAL THERAPY OF MYSTIC, LLC

Practice address

481 Gold Star Hwy
Suite 201
Groton, CT 06340-6702

Phone

(860) 445-9433

Fax

(860) 445-8802

NPI assigned

Jun 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ron A Agostini, PTNPI 1952596173

Title

Owner

Phone

(860) 445-9433

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ron A. Agostini, P.T.

  • Physical Therapist
  • Groton, CT
  • NPI 1952596173
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1245592617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 GOLD STAR HWY",
            "address_2": "SUITE 201",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406702",
            "telephone_number": "860-445-9433",
            "fax_number": "860-445-8802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 GOLD STAR HWY",
            "address_2": "SUITE 201",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406702",
            "telephone_number": "860-445-9433",
            "fax_number": "860-445-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY OF MYSTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-06-12",
        "status": "A",
        "authorized_official_last_name": "AGOSTINI",
        "authorized_official_first_name": "RON",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-445-9433",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "003770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phalanx Med Connecticut, LLC
• David Phelps Jr., DDS
• Phillips Integrative Health
• Christopher Phillips, IDC
• Laura Schmitt Phillips, BCTMB, LMT
• Janine M Pilney, LADC
• Pink Mermaid LLC
• Corrado Pitari, DC
• Mark Pochal, RPH
• Point Therapy, LLC

• Physical Therapist in Groton, CT
• Providers in Groton, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.