Kelly L Costa, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

037470 Issued in NY

Practice address

762 Deer Park Rd
Dix Hills, NY 11746-6221

Phone

(631) 254-0094

NPI assigned

Jan 4, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelly L Doyle Former name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1295156594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 KELSEY AVE",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117461139",
            "telephone_number": "631-697-3827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 DEER PARK RD",
            "city": "DIX HILLS",
            "state": "NY",
            "postal_code": "117466221",
            "telephone_number": "631-254-0094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTA",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-04",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "P91676",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "037470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DOYLE",
            "middle_name": "L",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah L Conroy, PT, DPT
• Jeanine Leanora Cook-Garard X, NP
• Marilyn F Cook, RN
• Dawn Cooper, RN
• Jennifer Corry
• Stacy Crescimanno
• Laurie A Crosse, MA, MT-BC, LCAT
• Diane Elizabeth Cuillo, COTA
• Kaitlyn Cummings
• D.I Optical Inc

• Physical Therapist in Dix Hills, NY
• Providers in Dix Hills, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.