Healthcare Provider Details

I. General information

NPI: 1821732355
Provider Name (Legal Business Name): CASEY MICHELLE ACOSTA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 OAK LAWN AVE STE 670
DALLAS TX
75219-4399
US

IV. Provider business mailing address

3500 OAK LAWN AVE STE 670
DALLAS TX
75219-4399
US

V. Phone/Fax

Practice location:
  • Phone: 214-528-3378
  • Fax:
Mailing address:
  • Phone: 214-528-3378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2168394
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: