MEDICARE: MEGAN ELISABETH ACOSTA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT5310	AR

General Provider Information

NPI Number	:	1306523238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELISABETH ACOSTA DPT

Provider Business Mailing Address
First Line	:	4301 W MARKHAM ST # 783
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7101
Country	:	US
Telephone Number	:	501-686-8000
Fax Number	:	501-526-5148

Provider Business Practice Location Address
First Line	:	4261 STOCKTON DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2916
Country	:	US
Telephone Number	:	501-526-5451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	09/27/2023

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