Provider Demographics
NPI:1770214959
Name:COSTA, MICHAEL A (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:COSTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 MORRIS AVE STE A101
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5746
Mailing Address - Country:US
Mailing Address - Phone:908-486-4400
Mailing Address - Fax:908-259-2760
Practice Address - Street 1:2333 MORRIS AVE STE A101
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5746
Practice Address - Country:US
Practice Address - Phone:908-486-4400
Practice Address - Fax:908-259-2760
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02093300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist