MEDICARE: MR. LISA GAIL FOSTER PT

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	2251P0200X	Pediatric Physical Therapist	8347	CO

General Provider Information

NPI Number	:	1619165362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LISA GAIL FOSTER PT

Provider Business Mailing Address
First Line	:	1120 W SOUTH BOULDER RD STE 201C
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8952
Country	:	US
Telephone Number	:	303-877-3599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 W SOUTH BOULDER RD STE 201C
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-8952
Country	:	US
Telephone Number	:	303-877-3599
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	08/11/2023

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