Provider Demographics
NPI:1245884766
Name:COSTELLO, CHELSEA (DPT)
Entity type:Individual
Prefix:
First Name:CHELSEA
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 1:1215 W 10TH ST. APT 305
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12656 W GEAUGA PLZ
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2505
Practice Address - Country:US
Practice Address - Phone:440-688-4186
Practice Address - Fax:440-686-4187
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist