MEDICARE: MRS. ELIZABETH H COSTANTINI MSPT

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	225100000X	Physical Therapist	11882	MA
2	225100000X	Physical Therapist	PT25451	FL

General Provider Information

NPI Number	:	1497737761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH H COSTANTINI MSPT

Provider Business Mailing Address
First Line	:	1944 N HERCULES AVE STE C
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-4403
Country	:	US
Telephone Number	:	727-797-8100
Fax Number	:	727-797-8110

Provider Business Practice Location Address
First Line	:	1944 N HERCULES AVE STE C
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-4403
Country	:	US
Telephone Number	:	727-797-8100
Fax Number	:	727-797-8110

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	02/07/2011

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