MEDICARE: CELIA N COSTARELLA LMP, BS

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	225700000X	Massage Therapist	MA60226364	WA

General Provider Information

NPI Number	:	1225315674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELIA N COSTARELLA LMP, BS

Provider Business Mailing Address
First Line	:	2220 NE 130TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-4244
Country	:	US
Telephone Number	:	510-333-9053
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 NE 130TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-4244
Country	:	US
Telephone Number	:	510-333-9053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/14/2011

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