Kenneth Patrick Costello

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2002005830 Issued in MO

Practice address

2937 S Brentwood Blvd
Brentwood, MO 63144

Phone

(314) 961-3804

Fax

(314) 961-1147

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Ken P. Costello Other name

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kenneth.costello.p2@direct.athleticoltd.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Athletico LTD

  • Physical Therapist
  • Liberty, MO
  • NPI 1114449857
  Medicare reassignment Care Compare group NPD
• Athletico LTD

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Physical Therapist

  NPD
• Athletico LTD

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1265586572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 OAKMONT LN",
            "address_2": "STE 600C",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605595548",
            "telephone_number": "630-575-6250",
            "fax_number": "630-575-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2937 S BRENTWOOD BLVD",
            "city": "BRENTWOOD",
            "state": "MO",
            "postal_code": "63144",
            "telephone_number": "314-961-3804",
            "fax_number": "314-961-1147"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10859 West Florissant Avenue",
            "address_purpose": "LOCATION",
            "city": "Ferguson",
            "state": "MO",
            "postal_code": "63136",
            "country_code": "US",
            "telephone_number": "314-521-3000",
            "fax_number": "314-521-7800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10859 West Florissant Avenue",
            "address_purpose": "LOCATION",
            "city": "Ferguson",
            "state": "MO",
            "postal_code": "63136",
            "country_code": "US",
            "telephone_number": "314-521-3000",
            "fax_number": "314-521-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "KENNETH",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2002005830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEN",
            "last_name": "COSTELLO",
            "middle_name": "P.",
            "prefix": "MR.",
            "credential": "M.P.T.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Therapist in Brentwood, MO
• Providers in Brentwood, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.