Provider Demographics
NPI:1336815448
Name:ACOSTA, PATRICIA ISABELA (DPT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ISABELA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ISABELA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2404 S LOCUST ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5789
Mailing Address - Country:US
Mailing Address - Phone:575-521-4188
Mailing Address - Fax:575-521-4188
Practice Address - Street 1:1845 NORTHWESTERN DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1157
Practice Address - Country:US
Practice Address - Phone:915-875-1559
Practice Address - Fax:915-877-9357
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1349904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1349904OtherTX PT LICENSE