Provider Demographics
NPI:1164898789
Name:AGOSTINO, RAYMOND (DPT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:AGOSTINO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 SW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5163
Mailing Address - Country:US
Mailing Address - Phone:239-848-8463
Mailing Address - Fax:855-289-1477
Practice Address - Street 1:1490 NE PINE ISLAND RD UNIT 6A-B
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2135
Practice Address - Country:US
Practice Address - Phone:239-848-8463
Practice Address - Fax:855-289-1477
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 30595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist