Healthcare Provider Details

I. General information

NPI: 1033877436
Provider Name (Legal Business Name): MARIEL FOSTER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIEL RUTKOWSKI PT, DPT

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 WATERLOO GENEVA RD
WATERLOO NY
13165-1457
US

IV. Provider business mailing address

1282 WATERLOO GENEVA RD
WATERLOO NY
13165-1457
US

V. Phone/Fax

Practice location:
  • Phone: 315-539-4683
  • Fax: 315-539-4684
Mailing address:
  • Phone: 315-539-4683
  • Fax: 315-539-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: