Provider Demographics
NPI:1609027705
Name:COSTA, LISA ELLIS (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ELLIS
Last Name:COSTA
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8B DAWSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-1310
Mailing Address - Country:US
Mailing Address - Phone:864-246-3135
Mailing Address - Fax:
Practice Address - Street 1:8B DAWSON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-1310
Practice Address - Country:US
Practice Address - Phone:864-246-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist