Provider Demographics
NPI:1881637734
Name:FOSTER, JON O (ATC, OTC)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:O
Last Name:FOSTER
Suffix:
Gender:M
Credentials:ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S COUNTRY CLUB DR
Mailing Address - Street 2:#2188
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3545
Mailing Address - Country:US
Mailing Address - Phone:480-964-1674
Mailing Address - Fax:
Practice Address - Street 1:12575 E VIA LINDA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4310
Practice Address - Country:US
Practice Address - Phone:480-484-7077
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer