Provider Demographics
NPI:1053798678
Name:COSTABILE, EMILY ANTOINETTE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANTOINETTE
Last Name:COSTABILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13733 N GATE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2214
Mailing Address - Country:US
Mailing Address - Phone:240-678-4927
Mailing Address - Fax:
Practice Address - Street 1:13733 N GATE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2214
Practice Address - Country:US
Practice Address - Phone:240-678-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer