Provider Demographics
NPI:1588431191
Name:FOUST, TRISTAN TERRANCE
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:TERRANCE
Last Name:FOUST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 1ST ST NW APT 304
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5828
Mailing Address - Country:US
Mailing Address - Phone:616-655-3483
Mailing Address - Fax:
Practice Address - Street 1:636 1ST ST NW APT 304
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5828
Practice Address - Country:US
Practice Address - Phone:616-655-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer