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Individual

JORDAN COSTELLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4201 E KNOX RD, PHOENIX, AZ 85044-4701
(480) 759-8449
Mailing address
490 E APPALOOSA RD, GILBERT, AZ 85296-2959
(480) 290-8269

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATR-009421
AZ
2255A2300X
Athletic Trainer
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
09/15/2020
Last updated
07/08/2022
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