Provider Demographics
NPI:1609185370
Name:FOSTER, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 COUNTY ROAD 1208
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-6700
Mailing Address - Country:US
Mailing Address - Phone:469-879-7219
Mailing Address - Fax:
Practice Address - Street 1:2191 S KIHEI RD
Practice Address - Street 2:APT 2404
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8627
Practice Address - Country:US
Practice Address - Phone:469-879-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist