MEDICARE: STEPHANNE FOSTER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT014265	GA

General Provider Information

NPI Number	:	1598475675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANNE FOSTER LMT

Provider Business Mailing Address
First Line	:	915 CUSTER AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3107
Country	:	US
Telephone Number	:	770-310-0774
Fax Number	:

Provider Business Practice Location Address
First Line	:	5819 CAMPBELLTON RD SW
Second Line	:
City	:	SOUTH FULTON
State	:	GA
Zip	:	30331-8046
Country	:	US
Telephone Number	:	404-491-1875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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