Individual
ADISLEN COSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2786 56TH ST SW, WYOMING, MI 49418-8708
(616) 260-9641
Mailing address
7667 COCONUT DR, JENISON, MI 49428-9170
(616) 260-9641
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501017889
MI
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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