Provider Demographics
NPI:1730204744
Name:FOSTER, MICHAEL P (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2846 EBERLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4402
Mailing Address - Country:US
Mailing Address - Phone:541-850-8909
Mailing Address - Fax:541-882-4005
Practice Address - Street 1:2846 EBERLEIN AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4402
Practice Address - Country:US
Practice Address - Phone:541-850-8909
Practice Address - Fax:541-882-4005
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6085225100000X
OR5424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR840161007OtherBLUE CROSS
OR139335Medicare PIN