Provider Demographics
NPI:1497737761
Name:COSTANTINI, ELIZABETH H (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:H
Last Name:COSTANTINI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 N HERCULES AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-4403
Mailing Address - Country:US
Mailing Address - Phone:727-797-8100
Mailing Address - Fax:727-797-8110
Practice Address - Street 1:1944 N HERCULES AVE STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-4403
Practice Address - Country:US
Practice Address - Phone:727-797-8100
Practice Address - Fax:727-797-8110
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11882225100000X
FLPT25451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69550Medicare ID - Type UnspecifiedMEDICARE