Provider Demographics
NPI:1548448269
Name:FOSTER, VINSON M (LMT, CMT)
Entity type:Individual
Prefix:MR
First Name:VINSON
Middle Name:M
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LMT, CMT
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 395
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-0395
Mailing Address - Country:US
Mailing Address - Phone:757-277-7330
Mailing Address - Fax:757-277-7330
Practice Address - Street 1:12388 WARWICK BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3850
Practice Address - Country:US
Practice Address - Phone:757-277-7330
Practice Address - Fax:757-277-7330
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019003820225700000X
NC5940225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist