Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 013863-1 | NY |
NPI | 1003117524 |
---|---|
Provider Name | Christine Foster |
First Address | Northport, NY 11768-2829 |
Second Address | Northport, NY 11768-2829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2010 |
Last Update Date | 15/11/2010 |