Provider Demographics
NPI:1578901716
Name:COSTAGLIOLA, KATRINA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:COSTAGLIOLA
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 1:35 QUEENS WAY
Mailing Address - Street 2:APT 4
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7732
Mailing Address - Country:US
Mailing Address - Phone:954-295-6635
Mailing Address - Fax:
Practice Address - Street 1:35 QUEENS WAY APT 4
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7732
Practice Address - Country:US
Practice Address - Phone:954-295-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18900225100000X
TX1228953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist