Provider Demographics
NPI:1528199775
Name:NORTHSTAR PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:NORTHSTAR PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:716-630-9700
Mailing Address - Street 1:2801 WEHRLE DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7381
Mailing Address - Country:US
Mailing Address - Phone:716-630-9700
Mailing Address - Fax:716-630-9200
Practice Address - Street 1:2801 WEHRLE DR
Practice Address - Street 2:SUITE 12
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-7381
Practice Address - Country:US
Practice Address - Phone:716-630-9700
Practice Address - Fax:716-630-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty