Provider Demographics
NPI:1164691648
Name:FOSTER, HAILEY SUSANN (PT)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:SUSANN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2536
Practice Address - Street 1:61470 S HIGHWAY 97
Practice Address - Street 2:SUITE 4
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2187
Practice Address - Country:US
Practice Address - Phone:541-585-1022
Practice Address - Fax:541-585-1024
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006860Medicaid
ORR156394Medicare PIN
OR6221370001Medicare NSC