Provider Demographics
NPI:1255461307
Name:ACOSTA, JUAN CARLOS (PT)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S.W. 31 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3823
Mailing Address - Country:US
Mailing Address - Phone:305-661-9060
Mailing Address - Fax:305-661-9060
Practice Address - Street 1:6851 S.W. 31 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3823
Practice Address - Country:US
Practice Address - Phone:305-661-9060
Practice Address - Fax:305-661-9060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 0010420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist