Provider Demographics
NPI:1407883382
Name:FOSTER, JEREMIAH THOMAS (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:THOMAS
Last Name:FOSTER
Suffix:
Gender:M
Credentials:ATC, CSCS
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Mailing Address - Street 1:4 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1613
Mailing Address - Country:US
Mailing Address - Phone:978-531-9453
Mailing Address - Fax:617-373-8278
Practice Address - Street 1:360 HUNTINGTON AVE
Practice Address - Street 2:140 MARINO CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5005
Practice Address - Country:US
Practice Address - Phone:617-373-7766
Practice Address - Fax:617-373-8278
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAAT-762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer