Individual
DR. JONATHAN LEEDS COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 TORREY PINES WAY, BRENTWOOD, TN 37027-8945
(814) 882-8936
Mailing address
3 TORREY PINES WAY, BRENTWOOD, TN 37027-8945
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD061822L
PA
Other
Enumeration date
08/28/2006
Last updated
08/03/2015
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