Provider Demographics
NPI:1023265329
Name:COSTA, PAMELA J (LMT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:COSTA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SAGEBRUSH DR
Mailing Address - Street 2:SUITE #116
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2733
Mailing Address - Country:US
Mailing Address - Phone:214-513-8684
Mailing Address - Fax:
Practice Address - Street 1:2651 SAGEBRUSH DR
Practice Address - Street 2:SUITE #116
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2733
Practice Address - Country:US
Practice Address - Phone:214-513-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT035900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist