Provider Demographics
NPI:1063503456
Name:FOSTER, THERESA M (MP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1917 N LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2634
Mailing Address - Country:US
Mailing Address - Phone:208-664-8194
Mailing Address - Fax:208-667-1847
Practice Address - Street 1:1101 E POLSTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6045
Practice Address - Country:US
Practice Address - Phone:208-773-8111
Practice Address - Fax:208-773-8385
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210660OtherWASH ST LABOR & INDUSTRY