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General NPI Number Information
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NPI Number | 1073103149
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Entity Type | Individual
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Provider Name | KENNETH JAMES BOS PTA
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Gender | Male
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 10001 S OSWEGO ST
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City | PARKER
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State | CO
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Zip | 80134-3786
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Country | US
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Telephone | 720-928-3229
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Fax |
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Provider Business Mailing Address
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Address Line | 11463 W PROGRESS PL
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City | LITTLETON
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State | CO
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Zip | 80127-1683
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Country | US
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Telephone | 303-903-3603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0014655
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License Number State | CO
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