Provider Demographics
NPI:1568883874
Name:DACOSTA, CHRISTINE MARY (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
Last Name:DACOSTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 N HANSON CT STE 301
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3186
Mailing Address - Country:US
Mailing Address - Phone:443-481-1140
Mailing Address - Fax:
Practice Address - Street 1:4175 N HANSON CT STE 301
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3186
Practice Address - Country:US
Practice Address - Phone:443-481-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24806225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation