Provider Demographics
NPI:1033638507
Name:BRISTOL, ANDREA (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:ARABADJIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2113
Mailing Address - Country:US
Mailing Address - Phone:781-235-5275
Mailing Address - Fax:
Practice Address - Street 1:62 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2113
Practice Address - Country:US
Practice Address - Phone:781-235-5275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist