Provider Demographics
NPI:1336980671
Name:COSTA, DAVID (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:COSTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 OLD NEW MILFORD RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2434
Mailing Address - Country:US
Mailing Address - Phone:203-350-6999
Mailing Address - Fax:203-350-6998
Practice Address - Street 1:60 OLD NEW MILFORD RD STE 2A
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2434
Practice Address - Country:US
Practice Address - Phone:203-350-6999
Practice Address - Fax:203-350-6998
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist