Provider Demographics
NPI:1790019768
Name:FOSTER, TRACEY LEE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:LEE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1815
Mailing Address - Country:US
Mailing Address - Phone:401-782-0363
Mailing Address - Fax:
Practice Address - Street 1:1000 DIVISION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2008
Practice Address - Country:US
Practice Address - Phone:401-885-1792
Practice Address - Fax:401-885-1794
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist