Provider Demographics
NPI:1710033188
Name:FOSTER, KRISTINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
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 1:5009 N EXECUTIVE DR STE B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4866
Mailing Address - Country:US
Mailing Address - Phone:309-839-8631
Mailing Address - Fax:855-579-3536
Practice Address - Street 1:5009 N EXECUTIVE DR STE B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-839-8631
Practice Address - Fax:855-579-3536
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-015329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist