Provider Demographics
NPI:1699342378
Name:BOSSAK, ALEC (PTA)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:BOSSAK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11574 W 106TH WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6672
Mailing Address - Country:US
Mailing Address - Phone:303-889-9014
Mailing Address - Fax:
Practice Address - Street 1:10081 WADSWORTH PKWY STE 120
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-3827
Practice Address - Country:US
Practice Address - Phone:303-465-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14220225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant