Provider Demographics
NPI:1083970636
Name:COSTA, SUSAN A (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:COSTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:BRAZIELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:210 JENNY LN
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-8358
Mailing Address - Country:US
Mailing Address - Phone:717-993-6257
Mailing Address - Fax:
Practice Address - Street 1:914 W MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-3610
Practice Address - Country:US
Practice Address - Phone:717-845-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-013706L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist