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1649319096
KENNETH COSTA
SALT LAKE CITY, UT
NPI
1649319096
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: UT 6022536-2401)
Enumeration Date
2007-02-05
Last Update Date
2007-07-08
Business Address
-- KENNETH COSTA
1952 FORT UNION BLVD # 100
SALT LAKE CITY, UT 84121-6877
Phone number: 801-942-3311
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Mailing Address
-- KENNETH COSTA
PO BOX 711185
SALT LAKE CITY, UT 84171-1185
Phone number: 801-942-3311
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