Provider Demographics
NPI:1518734219
Name:BOSMA, ALEXANDER MATHIAS (LNMT)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:MATHIAS
Last Name:BOSMA
Suffix:
Gender:M
Credentials:LNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:692 ECHO LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2072
Mailing Address - Country:US
Mailing Address - Phone:719-209-9045
Mailing Address - Fax:
Practice Address - Street 1:1710 BRIARGATE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3450
Practice Address - Country:US
Practice Address - Phone:719-268-6312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0023579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist