Provider Demographics
NPI:1033656384
Name:BOSCH, KATELYN ANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:ANNE
Last Name:BOSCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 FOXMOOR PL
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2320
Mailing Address - Country:US
Mailing Address - Phone:434-665-0211
Mailing Address - Fax:
Practice Address - Street 1:1155 FOXMOOR PL
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2320
Practice Address - Country:US
Practice Address - Phone:434-665-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225100000X
VA2305209627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty