Provider Demographics
NPI:1740483981
Name:FOSTER, MICHAEL W (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
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 1:4131 W LOOMIS RD
Mailing Address - Street 2:STE 200
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2051
Mailing Address - Country:US
Mailing Address - Phone:414-281-5151
Mailing Address - Fax:
Practice Address - Street 1:4131 W LOOMIS RD
Practice Address - Street 2:STE 200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2051
Practice Address - Country:US
Practice Address - Phone:414-281-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390806181Medicaid