Provider Demographics
NPI:1497051791
Name:COSTABILE HENK, AIMEE TOSHA (DPT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:TOSHA
Last Name:COSTABILE HENK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2415 PROFESSIONAL DR
Mailing Address - Street 2:PO BOX 7594
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2254
Mailing Address - Country:US
Mailing Address - Phone:252-443-0808
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:1501 N BICKETT BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2178
Practice Address - Country:US
Practice Address - Phone:919-497-8414
Practice Address - Fax:919-497-8478
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC11786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist