Provider Demographics
NPI:1366424210
Name:FOSTER, CHRISTOPHER EUGENE (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EUGENE
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 W STEWART AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4189
Mailing Address - Country:US
Mailing Address - Phone:541-500-8029
Mailing Address - Fax:541-622-8337
Practice Address - Street 1:771 W STEWART AVE
Practice Address - Street 2:STE 103
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-4189
Practice Address - Country:US
Practice Address - Phone:541-500-8029
Practice Address - Fax:541-622-8337
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4611225100000X
ALPTH2870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298053Medicaid
OR298053Medicaid