Provider Demographics
NPI:1477732121
Name:COSTA-SHEAHAN, ANDREA SOUZA (RPT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:SOUZA
Last Name:COSTA-SHEAHAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 SE 31ST TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3472
Mailing Address - Country:US
Mailing Address - Phone:239-673-8179
Mailing Address - Fax:239-347-3914
Practice Address - Street 1:504 SE 31ST TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3472
Practice Address - Country:US
Practice Address - Phone:239-673-8179
Practice Address - Fax:239-347-3914
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013317225100000X
FLPT28137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist