# PSYCHOPHYSICAL REHAB & RECOVERY P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700054400
- **Authorized official:** DR. JONATHAN L COSTA MD,PHD (PHYSICIAN)
- **Authorized official phone:** (814) 459-0585

## Contact information

- **Practice address:** 311 W 24TH ST, SUITE 306, ERIE, PA 16502-2665
- **Practice address phone:** (814) 459-0585
- **Practice address fax:** (814) 455-0239
- **Mailing address:** 311 W 24TH ST, SUITE 306, ERIE, PA 16502-2665
- **Mailing address phone:** (814) 459-0585
- **Mailing address fax:** (814) 455-0239

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | MD061822L | PA | Yes |

## Other

- **Enumeration date:** 02/15/2008
- **Last updated:** 01/26/2012