| NPI | 1700054400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN L COSTA Physician 814-459-0585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD061822L) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2012-01-26 |