Provider Demographics
NPI:1992182232
Name:FOSTER, ZOE (LMP)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-1062
Mailing Address - Country:US
Mailing Address - Phone:707-778-2164
Mailing Address - Fax:
Practice Address - Street 1:505 DUTCH HENRY CANYON
Practice Address - Street 2:
Practice Address - City:CALISTOGA
Practice Address - State:CA
Practice Address - Zip Code:94515
Practice Address - Country:US
Practice Address - Phone:707-778-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist