Organization
PSYCHOPHYSICAL REHAB & RECOVERY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN L COSTA MD,PHD (PHYSICIAN)
(814) 459-0585
Entity
Organization
Contact information
Practice address
311 W 24TH ST, SUITE 306, ERIE, PA 16502-2665
(814) 459-0585
(814) 455-0239
Mailing address
311 W 24TH ST, SUITE 306, ERIE, PA 16502-2665
(814) 459-0585
(814) 455-0239
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD061822L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166052
HIGHMARK
PA
Enumeration date
02/15/2008
Last updated
01/26/2012
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