Brant Edward Costilla, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2131372 Issued in TX

Practice address

2112 Forum Pkwy
Bedford, TX 76021-6028

Phone

(817) 799-4909

NPI assigned

Sep 30, 2020

Last updated

Sep 30, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1316554595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 WOOD DUCK CT",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760659427",
            "telephone_number": "469-222-7619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 FORUM PKWY",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760216028",
            "telephone_number": "817-799-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTILLA",
        "first_name": "BRANT",
        "middle_name": "EDWARD",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2131372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Qualonda Denise Crayton

• Physical Therapy Assistant in Bedford, TX
• Providers in Bedford, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.