Provider Demographics
NPI:1063252815
Name:CARESTIO, KRISTIN LEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LEE
Last Name:CARESTIO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 COUNTRY GATE LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9232
Mailing Address - Country:US
Mailing Address - Phone:843-471-6365
Mailing Address - Fax:
Practice Address - Street 1:155 COUNTRY GATE LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9232
Practice Address - Country:US
Practice Address - Phone:843-471-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13647225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist