Provider Demographics
NPI:1730348723
Name:FOSTER, MYLENE (RPT)
Entity type:Individual
Prefix:MRS
First Name:MYLENE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 SW 315TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3702
Mailing Address - Country:US
Mailing Address - Phone:253-661-3815
Mailing Address - Fax:253-445-4043
Practice Address - Street 1:920 12TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4920
Practice Address - Country:US
Practice Address - Phone:253-841-3422
Practice Address - Fax:253-445-4043
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist