Individual
KRISTIN ALLIE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
S31W24757 W SUNSET DR, WAUKESHA, WI 53189-7014
(262) 547-2250
(262) 547-2775
Mailing address
328 MAPLE WAY S, WAUKESHA, WI 53188-3911
(262) 894-3100
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12922-146
WI
Other
Enumeration date
09/09/2020
Last updated
09/16/2020
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