Provider Demographics
NPI:1730652967
Name:BOSELA, KRISTOPHER M (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:M
Last Name:BOSELA
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:112 ETNA RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1559
Mailing Address - Country:US
Mailing Address - Phone:603-643-7788
Mailing Address - Fax:603-643-0022
Practice Address - Street 1:10 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1865
Practice Address - Country:US
Practice Address - Phone:607-274-4159
Practice Address - Fax:607-274-4675
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
NY044036208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic