Provider Demographics
NPI:1184690216
Name:COSTELLO, NANCY IRENE (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:IRENE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1615
Mailing Address - Country:US
Mailing Address - Phone:847-298-2182
Mailing Address - Fax:
Practice Address - Street 1:8623 W BRYN MAWR AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3501
Practice Address - Country:US
Practice Address - Phone:773-693-2121
Practice Address - Fax:773-693-7148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist