Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
N | 2251C2600X | Cardiopulmonary | ||
N | 2251E1200X | Ergonomics | ||
N | 225XE1200X | Ergonomics | ||
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251H1200X | Hand | ||
N | 2251P0200X | Physical Therapist - Pediatrics | ||
N | 2251S0007X | Physical Therapist - Sports | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | PT37671 | CA |
NPI | 1952690901 |
---|---|
Provider Name | Dr. Cary Costa |
First Address | Lake Forest, CA 92630-1606 |
Second Address | Lake Forest, CA 92630-1606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 14/04/2016 |