1245712421 NPI number — KOKORO BODY THERAPIES, PLLC

Table of content: MICAELA GRACE COSTA FNP-C (NPI 1649957515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245712421 NPI number — KOKORO BODY THERAPIES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOKORO BODY THERAPIES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245712421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14850 MONTFORT DR STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254-7077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-201-3552
Provider Business Mailing Address Fax Number:
877-658-8663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14850 MONTFORT DR STE 181
Provider Second Line Business Practice Location Address:
LB 11
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75254-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-431-5656
Provider Business Practice Location Address Fax Number:
214-446-6010
Provider Enumeration Date:
09/04/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
ADRIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
214-550-1469

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)