Provider Demographics
NPI:1386191732
Name:COSTA, NICOLE OBENRADER (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:OBENRADER
Last Name:COSTA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:OBENRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4543 MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3108
Mailing Address - Country:US
Mailing Address - Phone:127-481-6164
Mailing Address - Fax:412-213-0881
Practice Address - Street 1:4543 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3108
Practice Address - Country:US
Practice Address - Phone:412-748-1616
Practice Address - Fax:412-213-0881
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist