Provider Demographics
NPI:1346383858
Name:COSTENIERO, CHRISTY SUE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:SUE
Last Name:COSTENIERO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ISLAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1100
Mailing Address - Country:US
Mailing Address - Phone:949-709-2203
Mailing Address - Fax:
Practice Address - Street 1:24731 ALICIA PKWY
Practice Address - Street 2:UNIT B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4653
Practice Address - Country:US
Practice Address - Phone:949-588-7278
Practice Address - Fax:949-588-7331
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 33262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist