Provider Demographics
NPI:1750076360
Name:FOSTER, BRIGDON KENTON JR (DPT)
Entity type:Individual
Prefix:DR
First Name:BRIGDON
Middle Name:KENTON
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 W WATROUS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5342
Mailing Address - Country:US
Mailing Address - Phone:813-787-2494
Mailing Address - Fax:
Practice Address - Street 1:2764 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6277
Practice Address - Country:US
Practice Address - Phone:813-787-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist