Provider Demographics
NPI:1811172661
Name:FOSTER, MATTHEW S (LPTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 SE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:MO
Mailing Address - Zip Code:64652-8128
Mailing Address - Country:US
Mailing Address - Phone:660-286-2415
Mailing Address - Fax:
Practice Address - Street 1:1622 E 28TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-1104
Practice Address - Country:US
Practice Address - Phone:660-359-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000276225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant