MEDICARE: ADILVANIA F DA COSTA RESTA

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	10173086-2401	UT

General Provider Information

NPI Number	:	1619608189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADILVANIA F DA COSTA RESTA

Provider Business Mailing Address
First Line	:	2576 S 900 E APT 2
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2556
Country	:	US
Telephone Number	:	954-773-1050
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 E 3900 S
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84107-2199
Country	:	US
Telephone Number	:	954-773-1050
Fax Number	:

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

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	06/23/2022

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Directions to “ ADILVANIA F DA COSTA RESTA ” Practice Location

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