Provider Demographics
NPI:1558442673
Name:KING, FOSTER A (DPT)
Entity Type:Individual
Prefix:
First Name:FOSTER
Middle Name:A
Last Name:KING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:7800 SW DURHAM RD
Practice Address - Street 2:SUITE500
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7577
Practice Address - Country:US
Practice Address - Phone:503-937-0090
Practice Address - Fax:503-372-5191
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9347225100000X
OR5926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COR27139Medicare UPIN