Provider Demographics
NPI:1467677617
Name:COSTANZO, KAREN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:
Last Name:COSTANZO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 WILLIAMS ST
Mailing Address - Street 2:UNIT 101
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1265
Mailing Address - Country:US
Mailing Address - Phone:410-641-0108
Mailing Address - Fax:
Practice Address - Street 1:9913 SEAHAWK RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3551
Practice Address - Country:US
Practice Address - Phone:410-641-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer