Provider Demographics
NPI:1528430592
Name:POSTELL, THERESA (MSOM LAC LMT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:POSTELL
Suffix:
Gender:F
Credentials:MSOM LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 HIGH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54180-1253
Mailing Address - Country:US
Mailing Address - Phone:920-619-4574
Mailing Address - Fax:
Practice Address - Street 1:450 HIGH ST STE 4
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:WI
Practice Address - Zip Code:54180-1253
Practice Address - Country:US
Practice Address - Phone:920-619-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI880-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist