Provider Demographics
NPI:1841758588
Name:FOSTER PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:FOSTER PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-691-2111
Mailing Address - Street 1:7209 N RICHLAND DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0654
Mailing Address - Country:US
Mailing Address - Phone:903-692-2111
Mailing Address - Fax:
Practice Address - Street 1:7209 N RICHLAND DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0654
Practice Address - Country:US
Practice Address - Phone:903-692-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962655563Medicaid
TX1346708245Medicaid