Basic Information
| Provider Information | |||||||||
| NPI: | 1710410253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | CRANDALL | ||||||||
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| Credential: | PT, DPT, OCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8322 BELLONA AVE | ||||||||
| Address2: | SUITE # 100 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212042065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103377900 | ||||||||
| FaxNumber: | 4107698591 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 PLUMTREE RD | ||||||||
| Address2: | SUITE # 301 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210156053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105698587 | ||||||||
| FaxNumber: | 4105693551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2017 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 26324 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 26324 | 01 | MD | PT LICENSE | OTHER |