Individual
MS. THERESA DIANE ACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
899 10TH AVE, ATHLETIC DEPT., NEW YORK, NY 10019-1069
(212) 237-8324
Mailing address
753 E 5TH ST, APT 3A, NEW YORK, NY 10009-1274
(817) 403-5140
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001384
NY
390200000X
Student in an Organized Health Care Education/Training Program
001384
NY
Other
Enumeration date
03/21/2006
Last updated
07/02/2008
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