Provider Demographics
NPI:1639847924
Name:KOSTA, MICHAEL J (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KOSTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 COMMERCE RD STE 402
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-9701
Mailing Address - Country:US
Mailing Address - Phone:540-416-0110
Mailing Address - Fax:540-416-0531
Practice Address - Street 1:1561 COMMERCE RD STE 402
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-9701
Practice Address - Country:US
Practice Address - Phone:540-416-0530
Practice Address - Fax:540-416-0531
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist