Individual
MR. KENNETH PATRICK COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2937 S BRENTWOOD BLVD, BRENTWOOD, MO 63144
(314) 961-3804
(314) 961-1147
Mailing address
600 OAKMONT LN, STE 600C, WESTMONT, IL 60559-5548
(630) 575-6250
(630) 575-7450
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2002005830
MO
Other
Enumeration date
01/23/2007
Last updated
07/01/2020
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