Provider Demographics
NPI:1528595824
Name:FOSTER, ANITA JOY (LMT)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:JOY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2215 PEBBLE CREEK DR APT 208J
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-3045
Mailing Address - Country:US
Mailing Address - Phone:440-252-4111
Mailing Address - Fax:440-252-4111
Practice Address - Street 1:8223 BRECKSVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1367
Practice Address - Country:US
Practice Address - Phone:440-252-4111
Practice Address - Fax:440-252-4111
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33022890225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14086114OtherCAQH