Individual
KENNETH COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1952 FORT UNION BLVD, # 100, SALT LAKE CITY, UT 84121-6877
(801) 942-3311
(801) 942-5955
Mailing address
PO BOX 711185, SALT LAKE CITY, UT 84171-1185
(801) 942-3311
(801) 942-5955
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6022536-2401
UT
Other
Enumeration date
02/05/2007
Last updated
07/08/2007
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