Individual
ANTONIO COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2641 BROOKSIDE DR, FOSTORIA, OH 44830-1304
(567) 207-0596
Mailing address
2641 BROOKSIDE DR, FOSTORIA, OH 44830-1304
(567) 207-0596
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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