Individual provider · NPI-1

Wayne P Costa, RKT

Kinesiotherapist · Lake City, FL

NPI number1598717498
StatusActive
Last updated in NPPESJul 13, 2026

Details

NPI
1598717498
Entity type
Individual (NPI-1)
Name
Mr. Wayne P Costa
Credential
RKT
Sex
Male
Sole proprietor
No
Enumeration date
May 17, 2006
Last updated
Jul 13, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
226300000X Kinesiotherapist––Yes

Practice location

619 S Marion Ave
Lake City, FL 32025-5808

Phone 386-755-3016

Mailing address

113 Sw Emily Gln
Lake City, FL 32024-3775

Phone 386-754-0136

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