Mary Sue Agostini, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

004064 Issued in 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

Last updated

Jul 13, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dynamic Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Pawcatuck, CT
  • NPI 1861682296

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1143849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1790746295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 SOUTH BROAD STREET",
            "address_2": "DYNAMIC PHYSICAL THERAPY LLC",
            "city": "PAWCATUCK",
            "state": "CT",
            "postal_code": "06379",
            "telephone_number": "860-599-0819",
            "fax_number": "860-599-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 SOUTH BROAD STREET",
            "address_2": "DYNAMIC PHYSICAL THERAPY LLC",
            "city": "PAWCATUCK",
            "state": "CT",
            "postal_code": "06379",
            "telephone_number": "860-599-0819",
            "fax_number": "860-599-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGOSTINI",
        "first_name": "MARY SUE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-01",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "004064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Chiropractic Wellness Center, LLC
• Anthony Frank Alessio, PHARMD
• Susan Alfiero-Bavasso
• Emily Jane Ambeau, LCSW
• Carlo Antonino, DC
• Brenda Louise Applegate, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.