Individual
ELYSE COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21008 76TH AVE W, EDMONDS, WA 98026-7104
(425) 778-0107
Mailing address
21008 76TH AVE W, EDMONDS, WA 98026-7104
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P160629979
WA
Other
Enumeration date
04/28/2016
Last updated
04/28/2016
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