Mary Sue Agostini, PT
Individual provider Active NPI Physical Therapist · Pawcatuck, CT
NPI 1790746295 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1790746295
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 004064 (CT)
- Practice address
- 158 South Broad Street
Dynamic Physical Therapy LLC
Pawcatuck, CT 06379 - Phone
- (860) 599-0819
- Fax
- (860) 599-0871
- NPI assigned
- Apr 1, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 004064 | CT | Yes |
Addresses
Primary practice location
158 South Broad Street
Dynamic Physical Therapy LLC
Pawcatuck, CT 06379
Mailing address
158 South Broad Street
Dynamic Physical Therapy LLC
Pawcatuck, CT 06379
Phone (860) 599-0819
Other providers in Pawcatuck, CT
- Advanced Chiropractic Wellness Center, LLC
- Anthony Frank Alessio
- Susan Alfiero-Bavasso
- Emily Jane Ambeau
- Carlo Antonino
- Brenda Louise Applegate
All providers in Pawcatuck, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.