Provider Demographics
NPI:1629096813
Name:COSTELLO, DANA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEMERCURIO DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1717
Mailing Address - Country:US
Mailing Address - Phone:201-818-2700
Mailing Address - Fax:201-818-3023
Practice Address - Street 1:1 DEMERCURIO DR
Practice Address - Street 2:SUITE 5
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1717
Practice Address - Country:US
Practice Address - Phone:201-818-2700
Practice Address - Fax:201-818-3023
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO9077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist