Individual
KRISTEN DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
54 N PARK AVE, SHREWSBURY, NJ 07702-4413
(917) 406-0478
Mailing address
152 KINGS HWY, MIDDLETOWN, NJ 07748-2023
(173) 269-3129
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT40QA00773200
NJ
Other
Enumeration date
06/12/2021
Last updated
06/12/2021
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