Provider Demographics
NPI:1639595176
Name:BRISTOL, LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3000 WILLISTON RD
Mailing Address - Street 2:STE 3
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6083
Mailing Address - Country:US
Mailing Address - Phone:802-324-0588
Mailing Address - Fax:802-863-9565
Practice Address - Street 1:1 MARKET PL
Practice Address - Street 2:SUITE 27
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2942
Practice Address - Country:US
Practice Address - Phone:802-658-6092
Practice Address - Fax:805-863-9565
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT040.0098735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist