Provider Demographics
NPI:1952479107
Name:COSTA, LORRAINE (PT)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4353 HYLAN BLVD
Mailing Address - Street 2:IN CARE OF DEVITA BECKER PHYSICAL THERAPY PC
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-967-3363
Mailing Address - Fax:718-967-5437
Practice Address - Street 1:4353 HYLAN BLVD
Practice Address - Street 2:DEVITA BECKER PHYSICAL THERAPY PC
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-967-3363
Practice Address - Fax:718-967-5437
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0131771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q86721Medicare ID - Type Unspecified