Provider Demographics
NPI:1306279617
Name:ACOSTA, GERARD CAOILE (PTA)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:CAOILE
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1311
Mailing Address - Country:US
Mailing Address - Phone:715-682-8172
Mailing Address - Fax:715-682-6662
Practice Address - Street 1:911 3RD ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1311
Practice Address - Country:US
Practice Address - Phone:715-682-8172
Practice Address - Fax:715-682-6662
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QP2000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist