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General NPI Number Information
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NPI Number | 1871756346
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Entity Type | Individual
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Provider Name | CHERYL COSTELLO PTA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2008
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Last Update Date | 06/28/2025
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Provider Practice Location Address
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Address Line | 1615 PASADENA AVE S STE 150
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-4517
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Country | US
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Telephone | 727-527-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 5901 E FOWLER AVE STE 100
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-2305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State | FL
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