Individual
JARED COSTABLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
372 PALMER AVENUE, PORTLAND, ME 04103
(207) 409-0718
Mailing address
372 PALMER AVENUE, PORTLAND, ME 04103
(207) 409-0718
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2905
ME
Other
Enumeration date
05/04/2007
Last updated
07/08/2007
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