Organization
COSTA REHAB AND WELLNESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARY COSTA D.P.T (CEO)
(971) 998-4484
Entity
Organization
Contact information
Practice address
22821 LAKE FOREST DR, SUITE 115, LAKE FOREST, CA 92630-1606
(949) 716-5050
(949) 482-2122
Mailing address
22821 LAKE FOREST DR, SUITE 115, LAKE FOREST, CA 92630-1606
(949) 716-5050
(949) 482-2122
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT37671
CA
2251C2600X
Cardiopulmonary Physical Therapist
PT37671
CA
2251E1200X
Ergonomics Physical Therapist
PT37671
CA
2251G0304X
Geriatric Physical Therapist
PT37671
CA
2251H1200X
Hand Physical Therapist
PT37671
CA
2251N0400X
Neurology Physical Therapist
PT37671
CA
2251P0200X
Pediatric Physical Therapist
PT37671
CA
2251S0007X
Sports Physical Therapist
PT37671
CA
2251X0800X
Orthopedic Physical Therapist
Primary
PT37671
CA
Other
Enumeration date
08/18/2014
Last updated
04/14/2016
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