Provider Demographics
NPI:1245354992
Name:FOSTER, DEBRA MAE (PTASST)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MAE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PTASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 NE PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1622
Mailing Address - Country:US
Mailing Address - Phone:816-478-3936
Mailing Address - Fax:573-392-1873
Practice Address - Street 1:LAKE REGIONAL HEALTH SYSTEM
Practice Address - Street 2:54 HOSPITAL DRIVE
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-392-3000
Practice Address - Fax:573-392-1873
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO114963225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant