Provider Demographics
NPI:1629802830
Name:REFORM PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:REFORM PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:RAGUSO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:347-266-6373
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy