Provider Demographics
NPI:1740241439
Name:FOSTER, CLINTON W (DPT)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:W
Last Name:FOSTER
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 1:3333 BAYSHORE BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1952
Mailing Address - Country:US
Mailing Address - Phone:713-943-1100
Mailing Address - Fax:713-943-1178
Practice Address - Street 1:3333 BAYSHORE BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1952
Practice Address - Country:US
Practice Address - Phone:713-943-1100
Practice Address - Fax:713-943-1178
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8902B0Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER