Provider Demographics
NPI:1922345271
Name:ACOSTA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ACOSTA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-312-0082
Mailing Address - Street 1:219-32 64TH AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364
Mailing Address - Country:US
Mailing Address - Phone:516-312-0082
Mailing Address - Fax:
Practice Address - Street 1:6134 188TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2719
Practice Address - Country:US
Practice Address - Phone:718-264-1979
Practice Address - Fax:718-254-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028426-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy