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General NPI Number Information
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NPI Number | 1497386841
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Entity Type | Individual
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Provider Name | SHAYLA DIANE FOSTER MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 2000 S MILLENIUM WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1551
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Country | US
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Telephone | 303-319-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 7529 W MIDDLE FORK ST
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City | BOISE
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State | ID
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Zip | 83709-6090
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Country | US
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Telephone | 303-319-3004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | AT-588
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License Number State | ID
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