Provider Demographics
NPI:1235146770
Name:FOSTER, WILLIAM R JR (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JONES HOLLOW RD STE 7
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1448
Mailing Address - Country:US
Mailing Address - Phone:860-295-8188
Mailing Address - Fax:860-295-8976
Practice Address - Street 1:14 JONES HOLLOW RD STE 7
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1448
Practice Address - Country:US
Practice Address - Phone:860-295-8188
Practice Address - Fax:860-295-8976
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007887CT02OtherBLUE CROSS BLUE SHIELD
CT004265056Medicaid
CT650001308Medicare UPIN