MEDICARE: ACOSTA PHYSICAL THERAPY, LLC

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

General Provider Information

NPI Number	:	1770280588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACOSTA PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	1429 S ARLINGTON AVE
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-2649
Country	:	US
Telephone Number	:	775-745-4724
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 MAYBERRY DR STE 101-6
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-2131
Country	:	US
Telephone Number	:	775-235-2834
Fax Number	:	702-820-2654

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	MR. BRENDAN PAUL ACOSTA
Credential	:	DPT
Telephone Number	:	775-745-4724

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	09/25/2023

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