Provider Demographics
NPI:1598355224
Name:D'COSTA, LAURA (PT, DPT, PAM-GC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:D'COSTA
Suffix:
Gender:F
Credentials:PT, DPT, PAM-GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 ARLINGTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4625
Mailing Address - Country:US
Mailing Address - Phone:703-970-6490
Mailing Address - Fax:703-970-6491
Practice Address - Street 1:8501 ARLINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4625
Practice Address - Country:US
Practice Address - Phone:703-970-6490
Practice Address - Fax:703-970-6491
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist