Provider Demographics
NPI:1336894302
Name:ACOSTA, JAVIER BEN (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:BEN
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 LINDENSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2195
Mailing Address - Country:US
Mailing Address - Phone:559-284-6827
Mailing Address - Fax:
Practice Address - Street 1:501 VES RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-4638
Practice Address - Country:US
Practice Address - Phone:434-386-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant