Provider Demographics
NPI:1477559235
Name:FOSTEK, MOLLY E (PT, MSPT, CMTPT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:E
Last Name:FOSTEK
Suffix:
Gender:F
Credentials:PT, MSPT, CMTPT
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:135 HANBURY RD W STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4291
Practice Address - Country:US
Practice Address - Phone:757-819-6512
Practice Address - Fax:757-819-6517
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790014629OtherBCBS PHYSICAL THERAPY
VA1477559235Medicaid
VA7615169OtherAETNA
VA192931OtherBCBS PHYSICAL THERAPY
VA192960OtherBCBS PHYSICAL THERAPY
VA650019847OtherRAILROAD MEDICARE
VA192960OtherBCBS PHYSICAL THERAPY
VA1790014629OtherBCBS PHYSICAL THERAPY
VAC05954Medicare PIN