Provider Demographics
NPI:1124327143
Name:ACOSTA, JOHN PAUL (AAS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2632
Mailing Address - Country:US
Mailing Address - Phone:573-353-1844
Mailing Address - Fax:
Practice Address - Street 1:206 W ROGERS ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2632
Practice Address - Country:US
Practice Address - Phone:573-353-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010035331225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant