Provider Demographics
NPI:1043778228
Name:ACOSTA, RITA MARIE (LAT, ATC, EMT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 CLARENCE ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3509
Mailing Address - Country:US
Mailing Address - Phone:651-402-6255
Mailing Address - Fax:
Practice Address - Street 1:410 S FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-7424
Practice Address - Country:US
Practice Address - Phone:651-402-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN989387146N00000X
GAAT0041402255A2300X
2255A2300X
MO20210334702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic