Provider Demographics
NPI:1548760978
Name:COSTANZA, AMANDA MARIE (PA-C, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:COSTANZA
Suffix:
Gender:F
Credentials:PA-C, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:TOCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5230 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1304
Mailing Address - Country:US
Mailing Address - Phone:412-647-7614
Mailing Address - Fax:
Practice Address - Street 1:5230 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1304
Practice Address - Country:US
Practice Address - Phone:412-647-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAMA065313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist