Provider Demographics
NPI:1306090766
Name:COSTELLO, LINDSAY MARIE (MPT)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MARIE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 GEIST RD
Mailing Address - Street 2:STE 12
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3569
Mailing Address - Country:US
Mailing Address - Phone:907-374-1981
Mailing Address - Fax:907-374-1983
Practice Address - Street 1:4001 GEIST RD
Practice Address - Street 2:STE 12
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3569
Practice Address - Country:US
Practice Address - Phone:907-374-1981
Practice Address - Fax:907-374-1983
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist