Individual provider · Type 1 NPI

Stanislav Kononov, LMT

Massage Therapist · Glendale, WI

NPI number 1922748169 Active

Practice location

5215 N Ironwood Rd Ste 104
Glendale, WI 53217-4908

Mailing address

2222 E Belleview Pl Apt 104
Milwaukee, WI 53211-4005

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X3048-146 (WI)

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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About NPI 1922748169

Stanislav Kononov, LMT's National Provider Identifier is 1922748169, issued on Mar 29, 2022. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Glendale, WI. The record was last updated on Mar 29, 2022.