Provider Demographics
NPI:1790199230
Name:FOSTER, KRISTA (LMT)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2146
Mailing Address - Country:US
Mailing Address - Phone:630-523-3402
Mailing Address - Fax:
Practice Address - Street 1:201 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3633
Practice Address - Country:US
Practice Address - Phone:630-325-2880
Practice Address - Fax:630-325-2890
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.006818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist