Provider Demographics
NPI:1962772475
Name:COSTANZO, NORINE R (PTA)
Entity type:Individual
Prefix:MRS
First Name:NORINE
Middle Name:R
Last Name:COSTANZO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 STRINGER ALY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8157
Mailing Address - Country:US
Mailing Address - Phone:843-884-7088
Mailing Address - Fax:
Practice Address - Street 1:369 STRINGER ALY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8157
Practice Address - Country:US
Practice Address - Phone:843-884-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0000018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant