Costello, Jacob Coy

Costello, Jacob Coy is an sole proprietor health care provider with primary practice located at 825 N 90Th St , Omaha NE 68114-2702. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Suppliers / Prosthetic/Orthotic Supplier. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is his primary health care specialty. Costello, Jacob Coy can be contacted via phone (402) 933-8900.

Contact Information

Primary practice address
825 N 90Th St Omaha NE 68114-2702
Phone: (402) 933-8900
Fax: (402) 393-9388
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 004086 Iowa
Suppliers / Prosthetic/Orthotic Supplier 335E00000X 2554 Nebraska
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 2554 Nebraska

Profile Details

NPI number 1275737470
LBN Legal business name Costello, Jacob Coy
Credentials DPT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 12th, 2007
Last updated Jun 12th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275737470 NPPES
Nebraska MEDICAID 10025410100
Nebraska Other CK3588
Nebraska MEDICAID 10025768700
Nebraska MEDICAID 47082113700
Nebraska Other P00453830

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