Provider Demographics
NPI:1336487735
Name:FOSTER, KRYSTAL (LMT)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
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 1:8433 W CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7934
Mailing Address - Country:US
Mailing Address - Phone:509-392-3199
Mailing Address - Fax:
Practice Address - Street 1:4206 W 24TH AVE APT A101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-9311
Practice Address - Country:US
Practice Address - Phone:509-392-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60203069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist