Individual
MARY JO COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
50 ROGERS AVE, LOCKPORT, NY 14094-2520
(716) 471-7232
Mailing address
58 BEVERLY AVE, LOCKPORT, NY 14094-2552
(716) 434-8530
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
014612
NY
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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