Healthcare Provider Details

I. General information

NPI: 1295626752
Provider Name (Legal Business Name): BROOKE COSTA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 GLOBE DR STE 111
MOUNT PLEASANT WI
53177-1616
US

IV. Provider business mailing address

13203 GLOBE DR STE 111
MOUNT PLEASANT WI
53177-1616
US

V. Phone/Fax

Practice location:
  • Phone: 262-287-0090
  • Fax: 262-923-1939
Mailing address:
  • Phone: 262-287-0090
  • Fax: 262-923-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: