Individual
MISS SHANNON BROOK COSTELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT, CERT MDT
Contact information
Practice address
2307 LAPORTE AVE, SUITE 5, VALPARAISO, IN 46383-6996
(219) 477-4500
(219) 477-4567
Mailing address
625 ENTERPRISE DR, OAK BROOK, IL 60523-8813
(630) 575-6200
(630) 928-5040
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007003A
IN
Other
Enumeration date
05/11/2006
Last updated
04/20/2017
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