Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT2422 | TN |
N | 2251X0800X | Physical Therapist - Orthopedic | PT2422 | TN |
NPI | 1336143833 |
---|---|
Provider Name | Dr. Kimberly A. Costello |
First Address | Johnson City, TN 37601-1403 |
Second Address | Johnson City, TN 37601-1403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 19/05/2010 |