Provider Demographics
NPI:1336581958
Name:BOSLEY, KIMBERLY D (ATC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20410 CENTURY BLVD
Mailing Address - Street 2:MEDSTAR NRH REHAB NETWORK - #215
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1186
Mailing Address - Country:US
Mailing Address - Phone:301-540-6140
Mailing Address - Fax:301-540-5190
Practice Address - Street 1:20410 CENTURY BLVD
Practice Address - Street 2:MEDSTAR NRH REHAB NETWORK - #215
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1186
Practice Address - Country:US
Practice Address - Phone:301-540-6140
Practice Address - Fax:301-540-5190
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00002622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer