Provider Demographics
NPI:1306860671
Name:BOSCH, KRISTOPHER DAVID (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:DAVID
Last Name:BOSCH
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 SEYMOUR JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6152
Mailing Address - Country:US
Mailing Address - Phone:702-652-9893
Mailing Address - Fax:
Practice Address - Street 1:8218 SEYMOUR JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191-6152
Practice Address - Country:US
Practice Address - Phone:702-652-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026488225100000X
NY0006052255A2300X
NV05062662255A2300X
NV2299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer