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Michael John Costello, PT
Orthopedic Physical Therapist in Ithaca, New York
NPI 1649593211

Michael John Costello is a Orthopedic Physical Therapist based in Ithaca, NY and is specialized in Orthopedic. Michael John Costello practices in Ithaca, NY and has the professional credentials of PT. The NPI Number for Michael John Costello is 1649593211 and holds a License No. 017819-1 (New York).

The current practice location address for Michael John Costello is 310 Taughannock Blvd, Ithaca, NY and can be reached out via phone at 607-252-3500 and via fax at 607-252-3505.

Location: 310 Taughannock Blvd, Ithaca, NY, 14850-3251
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1649593211
Provider Name
Michael John Costello
Credential
PT
Provider Entity Type
Individual
Gender
Male
Address
310 Taughannock Blvd, Ithaca, NY, 14850-3251
Phone Number
607-252-3500
Fax Number
607-252-3505
Provider Enumeration Date
03/10/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
22-2325405 01 NY EMPLOYER FEDERAL TAX IDENTIFICATION CAYUGA MEDICAL CENTER AT ITHACA
00332729 05 NY
institution
Provider Business Practice Location Address Details
Address
310 Taughannock Blvd
City
Ithaca
State
New York
Zip
14850-3251
Phone Number
607-252-3500
Fax Number
607-252-3505
person
Provider Business Mailing Address Details
Address
310 Taughannock Blvd
City
Ithaca
State
New York
Zip
14850-3251
Phone Number
607-252-3500
Fax Number
607-252-3505
person
Provider's Taxonomy Details 1
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Physical Therapist
Speciality
Orthopedic
Taxonomy
2251X0800X
License No.
017819-1 (New York)
Definition
A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopedic physical therapy theory and practice, and critical inquiry for evidence-based practice.
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