Healthcare Provider Details

I. General information

NPI: 1215273677
Provider Name (Legal Business Name): FOSTER WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 36TH AVE W STE 130
SEATTLE WA
98199-1675
US

IV. Provider business mailing address

4300 36TH AVE W STE 130
SEATTLE WA
98199-1675
US

V. Phone/Fax

Practice location:
  • Phone: 206-856-4096
  • Fax: 206-267-9491
Mailing address:
  • Phone: 206-856-4096
  • Fax: 206-267-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60114046
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00023193
License Number StateWA

VIII. Authorized Official

Name: GREG LEWERENZ
Title or Position: OWNER/PRACTITIONER
Credential: EAMP, LMP
Phone: 206-856-4096