MEDICARE: GIOVANNI COSTALES LMP

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	MA00018033	WA

General Provider Information

NPI Number	:	1124238167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIOVANNI COSTALES LMP

Provider Business Mailing Address
First Line	:	22108 52ND AVE W
Second Line	:
City	:	MOUNTLAKE TERRACE
State	:	WA
Zip	:	98043-4007
Country	:	US
Telephone Number	:	206-550-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	22108 52ND AVE W
Second Line	:
City	:	MOUNTLAKE TERRACE
State	:	WA
Zip	:	98043-4007
Country	:	US
Telephone Number	:	206-550-2205
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	03/03/2026

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