Provider Demographics
NPI:1033743257
Name:FOSTER, TERRECA ANTOINETTE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TERRECA
Middle Name:ANTOINETTE
Last Name:FOSTER
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 1:1518 HILL TOP CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-0879
Mailing Address - Country:US
Mailing Address - Phone:843-338-4157
Mailing Address - Fax:
Practice Address - Street 1:1518 HILL TOP CT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-0879
Practice Address - Country:US
Practice Address - Phone:843-338-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT132014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist