MEDICARE: JESSICA FOSTER D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT28946	FL

General Provider Information

NPI Number	:	1639618390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FOSTER D.P.T.

Provider Business Mailing Address
First Line	:	637 GREENGLEN LN
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3020
Country	:	US
Telephone Number	:	605-858-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	6767 86TH AVE N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-4597
Country	:	US
Telephone Number	:	727-548-5566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	02/14/2017

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