Provider Demographics
NPI:1184677700
Name:BOSELA, DAVID M (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:BOSELA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OLEAN ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2513
Mailing Address - Country:US
Mailing Address - Phone:716-652-3127
Mailing Address - Fax:716-652-3128
Practice Address - Street 1:19 OLEAN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2513
Practice Address - Country:US
Practice Address - Phone:716-652-3127
Practice Address - Fax:716-652-3128
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021719-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025451601OtherUNIVERA HEALTH INSURANCE
NY9311259OtherINDEPENDANT HEALTH INSURA
NY000626374001OtherBLUE CROSS BLUE SHIELD IN
NYRA4758Medicare ID - Type Unspecified
NY00025451601OtherUNIVERA HEALTH INSURANCE