Individual provider · NPI-1

Theresa Diane Acosta, ATC

Specialist/Technologist, Athletic Trainer · New York, NY

NPI number1962461608
StatusActive
Last updated in NPPESJul 2, 2008

Details

NPI
1962461608
Entity type
Individual (NPI-1)
Name
Ms. Theresa Diane Acosta
Credential
ATC
Sex
Female
Sole proprietor
No
Enumeration date
Mar 21, 2006
Last updated
Jul 2, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer001384NYYes
390200000X Student in an Organized Health Care Education/Training Program001384NY

Practice location

899 10th Ave
Athletic Dept.
New York, NY 10019-1069

Phone 212-237-8324

Mailing address

753 E 5th St
Apt 3a
New York, NY 10009-1274

Phone 817-403-5140

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