Healthcare Provider Details

I. General information

NPI: 1972076867
Provider Name (Legal Business Name): MILENA LUCHETTA DA COSTA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11720 MEDLOCK BRIDGE RD STE 550
JOHNS CREEK GA
30097-2505
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 678-364-7195
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013891
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: