Provider Demographics
NPI:1346260510
Name:FOSTER, AMY BETH (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:TIDMARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:8501 WOODHILL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8315
Mailing Address - Country:US
Mailing Address - Phone:704-248-7842
Mailing Address - Fax:980-343-3607
Practice Address - Street 1:8900 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7609
Practice Address - Country:US
Practice Address - Phone:980-343-3600
Practice Address - Fax:980-343-3607
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer