Individual
BRANT EDWARD COSTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2112 FORUM PKWY, BEDFORD, TX 76021-6028
(817) 799-4909
Mailing address
1814 WOOD DUCK CT, MIDLOTHIAN, TX 76065-9427
(469) 222-7619
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2131372
TX
Other
Enumeration date
09/30/2020
Last updated
09/30/2020
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