Jordan Costello
Specialist/Technologist, Athletic Trainer in Phoenix, AZ. Individual provider (NPI-1).
NPI number1962017947
StatusActive
Last updated in NPPESJul 8, 2022
Details
- NPI
- 1962017947
- Entity type
- Individual (NPI-1)
- Name
- Jordan Costello
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 15, 2020
- Certification date
- Jul 8, 2022
- Last updated
- Jul 8, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | ATR-009421 | AZ | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – |
Practice location
4201 E Knox RdPhoenix, AZ 85044-4701
Phone 480-759-8449
Mailing address
490 E Appaloosa RdGilbert, AZ 85296-2959
Phone 480-290-8269
Other practice locations
10045 E Madero Ave
Mesa, AZ 85209-1399
Mesa, AZ 85209-1399
Phone 480-290-8269
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