Provider Demographics
NPI:1982896213
Name:FORSTER, REBECCA GIRTZ (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:GIRTZ
Last Name:FORSTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:NM
Mailing Address - Zip Code:88312-1250
Mailing Address - Country:US
Mailing Address - Phone:505-937-2075
Mailing Address - Fax:
Practice Address - Street 1:2902 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6320
Practice Address - Country:US
Practice Address - Phone:505-937-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist