Individual
RONALD COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2040 NW NEWCASTLE ST, ROSEBURG, OR 97470-1657
(541) 673-1808
Mailing address
16083 SW UPPER BOONES FERRY RD, STE. 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5549
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00742611
RR MEDICARE
OR
Enumeration date
11/21/2007
Last updated
11/01/2012
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