Provider Demographics
NPI:1942753488
Name:FOSTER, BRIAN (RCEP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 QUEENS AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3082
Mailing Address - Country:US
Mailing Address - Phone:610-390-2230
Mailing Address - Fax:
Practice Address - Street 1:10 QUEENS AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3082
Practice Address - Country:US
Practice Address - Phone:610-390-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1029354224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist