Provider Demographics
NPI:1609164268
Name:ACOSTA, MARILOU ABESAMIS (PT)
Entity type:Individual
Prefix:MISS
First Name:MARILOU
Middle Name:ABESAMIS
Last Name:ACOSTA
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Gender:F
Credentials:PT
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Mailing Address - Street 1:3916 BOYDS BRIDGE PIKE
Mailing Address - Street 2:HOLSTON HEALTH AND REHAB CENTER
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-6233
Mailing Address - Country:US
Mailing Address - Phone:865-524-1500
Mailing Address - Fax:865-524-0408
Practice Address - Street 1:3916 BOYDS BRIDGE PIKE
Practice Address - Street 2:HOLSTON HEALTH AND REHAB CENTER
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-6233
Practice Address - Country:US
Practice Address - Phone:865-524-1500
Practice Address - Fax:865-524-0408
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNTN8275225100000X
MOMO2007017263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist