Individual
KIRSTIN ANNE FOSBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6601 220TH ST SW, STE 1, MOUNTLAKE TERRACE, WA 98043-2166
(425) 775-7274
(425) 775-0963
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00005491
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0290893
DEPT. OF LABOR AND INDUSTRIES
WA
05
—
1558677302
—
WA
Enumeration date
08/30/2010
Last updated
07/06/2015
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