Provider Demographics
NPI:1417261439
Name:COSTA, JULIANNE (PT, OTR)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:PT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 MANHATTAN AVE
Mailing Address - Street 2:#4L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:454 MANHATTAN AVE
Practice Address - Street 2:#4L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1088
Practice Address - Country:US
Practice Address - Phone:917-916-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022662-12251P0200X
NY012810-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics