Provider Demographics
NPI:1972779684
Name:KOSTES, BRETT THOMAS
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:THOMAS
Last Name:KOSTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8546
Mailing Address - Country:US
Mailing Address - Phone:630-243-0400
Mailing Address - Fax:
Practice Address - Street 1:1363 OVERTON DR
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-8546
Practice Address - Country:US
Practice Address - Phone:630-243-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-008008172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist