Individual
FOSTER DEARISO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC, LAT
Contact information
Practice address
1955 NOCTURNE DR UNIT 3410, ALPHARETTA, GA 30009-4830
(478) 696-2483
Mailing address
1955 NOCTURNE DR UNIT 3410, ALPHARETTA, GA 30009-4830
(478) 696-2483
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT016487
GA
2255A2300X
Athletic Trainer
AT002784
GA
Other
Enumeration date
08/27/2015
Last updated
03/13/2023
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