Provider Demographics
NPI:1568014603
Name:RAGUSO, MARISA NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:NICOLE
Last Name:RAGUSO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 REYNOLDS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4600
Mailing Address - Country:US
Mailing Address - Phone:347-266-6373
Mailing Address - Fax:
Practice Address - Street 1:991 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5363
Practice Address - Country:US
Practice Address - Phone:347-377-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101218-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist