Healthcare Provider Details

I. General information

NPI: 1497091714
Provider Name (Legal Business Name): LAURA L FOSTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 STATE ROAD 32 E
WESTFIELD IN
46074-8767
US

IV. Provider business mailing address

1000 S MAIN ST
TIPTON IN
46072-9753
US

V. Phone/Fax

Practice location:
  • Phone: 877-366-2663
  • Fax: 317-867-3798
Mailing address:
  • Phone: 765-675-1400
  • Fax: 765-675-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005310A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: