Provider Demographics
NPI:1114455268
Name:FOSTER, KOLE DANIEL (DPT)
Entity type:Individual
Prefix:DR
First Name:KOLE
Middle Name:DANIEL
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:KOLE
Other - Middle Name:DANIEL
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:2355 S SEDONA CT
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-8615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2578
Practice Address - Country:US
Practice Address - Phone:417-328-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1291488208100000X
MO2021035307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation