Provider Demographics
NPI:1235146770
Name:FOSTER, WILLIAM R JR (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:FOSTER
Suffix:JR
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 1:140 MAIN ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3437
Mailing Address - Country:US
Mailing Address - Phone:860-343-9572
Mailing Address - Fax:860-343-0239
Practice Address - Street 1:140 MAIN ST STE 4B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3437
Practice Address - Country:US
Practice Address - Phone:860-343-9572
Practice Address - Fax:860-343-0239
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X
CT7887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004265056Medicaid
CT080007887CT02OtherBLUE CROSS BLUE SHIELD
CT650001308Medicare UPIN