Provider Demographics
NPI:1215273677
Name:FOSTER WELLNESS
Entity type:Organization
Organization Name:FOSTER WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWERENZ
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP, LMP
Authorized Official - Phone:206-856-4096
Mailing Address - Street 1:4300 36TH AVE W STE 130
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1675
Mailing Address - Country:US
Mailing Address - Phone:206-856-4096
Mailing Address - Fax:206-267-9491
Practice Address - Street 1:4300 36TH AVE W STE 130
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1675
Practice Address - Country:US
Practice Address - Phone:206-856-4096
Practice Address - Fax:206-267-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60114046171100000X
WAMA00023193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty