MEDICARE: DR. KRISTOPHER DAVID BOSCH PT, DPT, ATC

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	026488	NY
2	2255A2300X	Athletic Trainer	000605	NY
3	2255A2300X	Athletic Trainer	0506266	NV
4	225100000X	Physical Therapist	2299	NV

General Provider Information

NPI Number	:	1306860671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTOPHER DAVID BOSCH PT, DPT, ATC

Provider Business Mailing Address
First Line	:	8218 SEYMOUR JOHNSON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89191-6152
Country	:	US
Telephone Number	:	702-652-9893
Fax Number	:

Provider Business Practice Location Address
First Line	:	8218 SEYMOUR JOHNSON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89191-6152
Country	:	US
Telephone Number	:	702-652-9893
Fax Number	:

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/09/2023

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