Kristopher M Bosela, PT, DPT, OCS

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

044036 Issued in NY

Practice address

10 Brentwood Dr
Ithaca, NY 14850-1865

Phone

(607) 274-4159

Fax

(607) 274-4675

NPI assigned

Jan 10, 2019

Last updated

Dec 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1730652967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 ETNA RD",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037661559",
            "telephone_number": "603-643-7788",
            "fax_number": "603-643-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BRENTWOOD DR",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501865",
            "telephone_number": "607-274-4159",
            "fax_number": "607-274-4675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Etna Rd",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "037661559",
            "country_code": "US",
            "telephone_number": "603-643-7788",
            "fax_number": "603-643-0022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 Taughannock Blvd Ste 5A",
            "address_purpose": "LOCATION",
            "city": "Ithaca",
            "state": "NY",
            "postal_code": "148503251",
            "country_code": "US",
            "telephone_number": "607-253-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSELA",
        "first_name": "KRISTOPHER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, OCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-10",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "044036",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolina F Borden, LCSW
• Emily Louise Bordlemay
• Vanessa Borotz
• Tammy Marie Borrelli, CASAC
• Amy Klingaman Boscia, O.D.
• Sarah Botsford, MPT
• Madison Antionette Boutureira
• Alyssa G Bovalino, PA-C
• Sarah Marie Bower, OTR/L
• Katie Erin Bowers, DPT

• Physical Medicine & Rehabilitation Physician in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.