National Provider Identifier
Kristopher M Bosela, PT, DPT, OCS
Kristopher M Bosela, PT, DPT, OCS is listed in the NPPES registry with a primary specialty of Physical Medicine & Rehabilitation Physician in Ithaca, NY and a listed phone number of (607) 274-4159.
Profile Overview
- NPI
- 1730652967
- Provider Type
- Individual
- Primary Specialty
- Physical Medicine & Rehabilitation Physician
- Enumeration Date
- January 10, 2019
- Last Updated
- December 21, 2022
Practice Location
- 10 Brentwood Dr
- Ithaca, NY 14850-1865
Phone: (607) 274-4159
Mailing Address
- 112 Etna RD
- Lebanon, NH 03766-1559
Specialties
- Physical Medicine & Rehabilitation Physician (208100000X)
- Orthopedic Physical Therapist (2251X0800X)
Full Record
- NPI
- 1730652967
- Entity Type
- Individual
- Last Name
- Bosela
- First Name
- Kristopher
- Middle Name
- M
- Name Prefix
- Dr.
- Credential
- PT, DPT, OCS
- Mailing Street Address
- 112 Etna RD
- Mailing City
- Lebanon
- Mailing State
- NH
- Mailing ZIP Code
- 03766-1559
- Mailing Country
- US
- Mailing Phone
- (603) 643-7788
- Mailing Fax
- (603) 643-0022
- Practice Street Address
- 10 Brentwood Dr
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-1865
- Practice Country
- US
- Practice Phone
- (607) 274-4159
- Practice Fax
- (607) 274-4675
- Enumeration Date
- January 10, 2019
- Last Updated
- December 21, 2022
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- December 21, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physical Medicine & Rehabilitation Physician (208100000X), Orthopedic Physical Therapist (2251X0800X)