Provider Demographics
NPI:1821846403
Name:COSTERS, CHRIS JULIEN
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:JULIEN
Last Name:COSTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2379 RESERVATION RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2539
Mailing Address - Country:US
Mailing Address - Phone:850-512-4650
Mailing Address - Fax:
Practice Address - Street 1:600 W GREGORY ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4744
Practice Address - Country:US
Practice Address - Phone:850-434-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6113261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy