MEDICARE: KELLY BOSSOLA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT016522	PA
2	2251P0200X	Pediatric Physical Therapist	PT016522	PA

General Provider Information

NPI Number	:	1811177322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BOSSOLA PT

Provider Business Mailing Address
First Line	:	PO BOX 40000
Second Line	:
City	:	VAIL
State	:	CO
Zip	:	81658-7520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 BEARD CREEK RD STE 1100
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6433
Country	:	US
Telephone Number	:	970-569-7777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/03/2025

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Directions to “ KELLY BOSSOLA PT” Practice Location

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