Individual
MR. WAYNE P COSTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RKT
Contact information
Practice address
619 S MARION AVE, LAKE CITY, FL 32025-5808
(386) 755-3016
Mailing address
113 SW EMILY GLN, LAKE CITY, FL 32024-3775
(386) 754-0136
Taxonomy
Speciality
Code
Description
License number
State
226300000X
Kinesiotherapist
Primary
—
—
Other
Enumeration date
05/17/2006
Last updated
07/08/2007
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