Most Relevant Information
Provider Data
| NPI Number: | 1003568007 |
| Provider Name: | CHERYL LYNN COSTIN PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | A2559 |
Most Important Dates
| Enumeration Date: | 01/20/2022 |
| Last Updated: | 01/20/2022 |
Provider Practice Location
1311 S MAIN ST STE 301
MOUNT AIRY
MD
217715464
Practice Location Phone/Fax
| Phone: | 3016079096 |
| Fax: | 3018291320 |
Provider Mailing Location
1311 S MAIN ST STE 301
MOUNT AIRY
MD
217715464
Provider Mailing Phone/Fax
| Phone: | 3016079096 |
| Fax: | 3018291320 |