MEDICARE: MR. RAYMOND AGOSTINO DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 30595	FL

General Provider Information

NPI Number	:	1164898789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND AGOSTINO DPT

Provider Business Mailing Address
First Line	:	1145 SW 37TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5163
Country	:	US
Telephone Number	:	239-848-8463
Fax Number	:	855-289-1477

Provider Business Practice Location Address
First Line	:	1490 NE PINE ISLAND RD UNIT 6A-B
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2135
Country	:	US
Telephone Number	:	239-848-8463
Fax Number	:	855-289-1477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	03/09/2021

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