Provider Demographics
NPI:1366698037
Name:FOSDICK, KERSTIN LOUISE (LPT)
Entity type:Individual
Prefix:MS
First Name:KERSTIN
Middle Name:LOUISE
Last Name:FOSDICK
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 SEA WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:TX
Mailing Address - Zip Code:78124-6520
Mailing Address - Country:US
Mailing Address - Phone:830-420-3354
Mailing Address - Fax:210-651-3495
Practice Address - Street 1:17530 OLD EVANS RD
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-3801
Practice Address - Country:US
Practice Address - Phone:210-651-9574
Practice Address - Fax:210-651-3495
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1083442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist