MEDICARE: ANNAREYA COSTALES

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

General Provider Information

NPI Number	:	1013551571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNAREYA COSTALES

Provider Business Mailing Address
First Line	:	8414 NW 103RD ST APT 103
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-4671
Country	:	US
Telephone Number	:	786-506-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	8414 NW 103RD ST APT 103
Second Line	:
City	:	HIALEAH GDNS
State	:	FL
Zip	:	33016-4671
Country	:	US
Telephone Number	:	786-506-0372
Fax Number	:

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

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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Directions to “ ANNAREYA COSTALES ” Practice Location

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