| Doctor Name: | THOMAS E COSTELLO |
| NPI Number: | 1093957342 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., P.T. |
| License Number: | 011915 |
| Business Practice Address: | 125 Oakland Ave Suite 205 Port Jefferson, NY - 117772130 |
| Business Phone Number: | 6316862523 |
| Business Fax Number: | 6316862525 |
| Mailing Address: | 75 N Country Rd, Attn: Patricia Schindler, Revenue Cycle Management PORT JEFFERSON |
| State: | NY |
| Postal Code: | 117772119 |
| Phone Number: | 6316867809 |
| Fax Number: | |
| NPI Enumeration Date: | 04/01/2009 |
| NPI Last Update Date: | 01/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 011915 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |