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General NPI Number Information
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NPI Number | 1467419424
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Entity Type | Individual
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Provider Name | AMANDA S COSTABILE P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 700 GEIPE RD STE 240
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City | CATONSVILLE
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State | MD
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Zip | 21228-4147
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Country | US
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Telephone | 410-747-8571
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Fax | 410-747-9050
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Provider Business Mailing Address
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Address Line | 7110 HARLAN LN
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City | SYKESVILLE
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State | MD
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Zip | 21784-7559
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Country | US
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Telephone | 410-549-9225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 16491
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License Number State | MD
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