Provider Demographics
NPI:1699070623
Name:COSTA, ADRIANE E (PT)
Entity type:Individual
Prefix:MRS
First Name:ADRIANE
Middle Name:E
Last Name:COSTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 TICE VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2224
Mailing Address - Country:US
Mailing Address - Phone:925-935-0510
Mailing Address - Fax:925-935-0750
Practice Address - Street 1:101 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4087
Practice Address - Country:US
Practice Address - Phone:925-944-0110
Practice Address - Fax:925-944-0960
Is Sole Proprietor?:No
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist