Provider Demographics
NPI:1083969638
Name:BRISTOL, RYAN G (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:G
Last Name:BRISTOL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 WARD AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2131
Mailing Address - Country:US
Mailing Address - Phone:808-381-3947
Mailing Address - Fax:808-591-2245
Practice Address - Street 1:932 WARD AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2131
Practice Address - Country:US
Practice Address - Phone:808-381-3947
Practice Address - Fax:808-591-2245
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI99-0353213OtherHMAA
HI99-0353213OtherUHA