Provider Demographics
NPI:1497386841
Name:FOSTER, SHAYLA DIANE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:DIANE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 W MIDDLE FORK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6090
Mailing Address - Country:US
Mailing Address - Phone:303-319-3004
Mailing Address - Fax:
Practice Address - Street 1:2000 S MILLENIUM WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1551
Practice Address - Country:US
Practice Address - Phone:303-319-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-5882083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine