Provider Demographics
NPI:1902500119
Name:FOISY, KIMBERLY MYA (LMT, PPMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MYA
Last Name:FOISY
Suffix:
Gender:F
Credentials:LMT, PPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 N BEDFORD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1173
Mailing Address - Country:US
Mailing Address - Phone:774-257-4764
Mailing Address - Fax:
Practice Address - Street 1:56 N BEDFORD ST STE 1
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1173
Practice Address - Country:US
Practice Address - Phone:774-257-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist