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General NPI Number Information
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NPI Number | 1386353449
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Entity Type | Individual
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Provider Name | CANDIDA MICHELLE COSENTINO LMT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 250 MAIN ST
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City | SUGAR GROVE
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State | IL
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Zip | 60554-5443
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Country | US
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Telephone | 844-762-0735
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 SURREY CT
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City | AURORA
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State | IL
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Zip | 60506-4447
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Country | US
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Telephone | 331-806-6094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT22207844
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.022776
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License Number State | IL
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