Healthcare Provider Details

I. General information

NPI: 1437007739
Provider Name (Legal Business Name): EMILY ARDEN COSTELLO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 POLE LINE RD
TWIN FALLS ID
83301
US

IV. Provider business mailing address

605 BROADWAY AVE N
BUHL ID
83316-1531
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-1000
  • Fax:
Mailing address:
  • Phone: 916-765-6625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4771787
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: