Individual
AMANDA COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
211 EXECUTIVE DR, SUITE 11, NEWARK, DE 19702-3357
(302) 793-1800
Mailing address
211 EXECUTIVE DR, SUITE 11, NEWARK, DE 19702-3357
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
A00711
MD
2255A2300X
Athletic Trainer
Primary
J3-0000438
DE
2255A2300X
Athletic Trainer
RTO000108
PA
Other
Enumeration date
07/09/2015
Last updated
07/09/2015
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