Provider Demographics
NPI:1568752715
Name:BRISTOL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BRISTOL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMARATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-589-0444
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-0132
Mailing Address - Country:US
Mailing Address - Phone:860-589-0444
Mailing Address - Fax:860-314-1588
Practice Address - Street 1:400 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-8405
Practice Address - Country:US
Practice Address - Phone:860-589-0444
Practice Address - Fax:860-314-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty