Provider Demographics
NPI:1629454616
Name:FOSTER, MICHAEL (MS, ATC, LAT, CES)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MS, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MONROE ST NE
Mailing Address - Street 2:APT. 218
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 MONROE ST NE
Practice Address - Street 2:APT. 218
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1776
Practice Address - Country:US
Practice Address - Phone:209-985-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00007032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer