Provider Demographics
NPI:1144593872
Name:FOSTER, NATHANIEL (PTA)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E CHESTER ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1191
Mailing Address - Country:US
Mailing Address - Phone:513-602-0928
Mailing Address - Fax:
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1716
Practice Address - Country:US
Practice Address - Phone:303-702-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8792225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant