Provider Demographics
NPI:1467018234
Name:BRISTER, CHRISTINA JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JEAN
Last Name:BRISTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FULLER LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-6701
Mailing Address - Country:US
Mailing Address - Phone:270-724-3000
Mailing Address - Fax:
Practice Address - Street 1:1500 PRIDE AVE
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9157
Practice Address - Country:US
Practice Address - Phone:270-821-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant