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Contact Information

KENNETH P COSTELLO
2937 S BRENTWOOD BLVD
BRENTWOOD, MO63144
 Phone: 314-961-3804
 Fax: 314-961-1147
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for KENNETH P COSTELLO · (Male)

NPI Number 1265586572
Status Active
Credentials
Entity Individual
Enumeration date 01/23/2007
Last updated 07/01/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • MO License # 2002005830
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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