Provider Demographics
NPI:1982251203
Name:BOSCH, AARON (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:BOSCH
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-9022
Mailing Address - Country:US
Mailing Address - Phone:616-717-0752
Mailing Address - Fax:
Practice Address - Street 1:208 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-9022
Practice Address - Country:US
Practice Address - Phone:616-717-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0832462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer