Provider Demographics
NPI:1326752775
Name:FOSTER, MADASEN (LMT)
Entity Type:Individual
Prefix:
First Name:MADASEN
Middle Name:
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 1:824 3RD ST NE APT C
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-2914
Mailing Address - Country:US
Mailing Address - Phone:253-754-4930
Mailing Address - Fax:
Practice Address - Street 1:1011 E MAIN STE 403
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6776
Practice Address - Country:US
Practice Address - Phone:206-229-2786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61373337225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist