Provider Demographics
NPI:1750674487
Name:FOSTER, JEFFREY L (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
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 1:410 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2609
Mailing Address - Country:US
Mailing Address - Phone:402-721-3908
Mailing Address - Fax:402-721-4047
Practice Address - Street 1:410 E 22ND ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2609
Practice Address - Country:US
Practice Address - Phone:402-721-3908
Practice Address - Fax:402-721-4047
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47623OtherBLUE CROSS BLUE SHIELD
NE098958018Medicare PIN