Provider Demographics
NPI:1962614792
Name:COSTELLO, CHARLES THOMAS (PT, CHT)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17614 CASSINA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5789
Mailing Address - Country:US
Mailing Address - Phone:281-350-1223
Mailing Address - Fax:713-794-2071
Practice Address - Street 1:TEXAS WOMAN'S UNIVERSITY
Practice Address - Street 2:6700 FANNIN ST
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2343
Practice Address - Country:US
Practice Address - Phone:713-794-2070
Practice Address - Fax:713-794-2071
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist