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General NPI Number Information
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NPI Number | 1215273677
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Entity Type | Organization
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Legal Business Name | FOSTER WELLNESS
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 4300 36TH AVE W STE 130
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City | SEATTLE
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State | WA
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Zip | 98199-1675
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Country | US
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Telephone | 206-856-4096
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Fax | 206-267-9491
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Provider Business Mailing Address
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Address Line | 4300 36TH AVE W STE 130
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City | SEATTLE
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State | WA
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Zip | 98199-1675
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Country | US
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Telephone | 206-856-4096
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Fax | 206-267-9491
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | GREG LEWERENZ
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Credential | EAMP, LMP
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Telephone | 206-856-4096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00023193
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60114046
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License Number State | WA
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