Provider Demographics
NPI:1295887065
Name:FOSTER, MARC (PT, MS)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AUBURN CREST CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8231
Mailing Address - Country:US
Mailing Address - Phone:530-865-8457
Mailing Address - Fax:530-865-8462
Practice Address - Street 1:1014 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1671
Practice Address - Country:US
Practice Address - Phone:530-865-8457
Practice Address - Fax:530-865-8462
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT260680Medicare ID - Type Unspecified