Provider Demographics
NPI:1962655563
Name:FOSTER, WARREN CHRIS (PT)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:CHRIS
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:903-691-2111
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:903-691-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1112076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134670824Medicaid
TX1841758588Medicaid