Individual
MRS. CHERYL JANE COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
833 16TH AVE, MOLINE, IL 61265-3808
(309) 764-6744
Mailing address
2137 THORNWOOD LN, LE CLAIRE, IA 52753-9313
(563) 332-4365
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
160.004681
IL
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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