Provider Demographics
NPI:1811397482
Name:COSTA, STEFANIE (DPT)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:COSTA
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 1:934 N UNIVERSITY DR STE 219
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7029
Mailing Address - Country:US
Mailing Address - Phone:954-323-2247
Mailing Address - Fax:954-344-9708
Practice Address - Street 1:21355 E DIXIE HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1238
Practice Address - Country:US
Practice Address - Phone:786-923-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist