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:
Health care specialties
| Specialty | Code | License # | 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 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275737470 | NPPES |
| Nebraska | MEDICAID | 10025410100 | |
| Nebraska | Other | CK3588 | |
| Nebraska | MEDICAID | 10025768700 | |
| Nebraska | MEDICAID | 47082113700 | |
| Nebraska | Other | P00453830 |
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