Provider Demographics
NPI:1215058755
Name:FOSTER, DEBRALEE L (LMT)
Entity type:Individual
Prefix:
First Name:DEBRALEE
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:NY
Mailing Address - Zip Code:13464-2710
Mailing Address - Country:US
Mailing Address - Phone:607-627-6208
Mailing Address - Fax:
Practice Address - Street 1:149 FOSTER RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:NY
Practice Address - Zip Code:13464-2710
Practice Address - Country:US
Practice Address - Phone:607-627-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist