Provider Demographics
NPI:1760519177
Name:BRISTOL PHYSICAL THERAPY & SPORTS MEDICINE CENTER
Entity Type:Organization
Organization Name:BRISTOL PHYSICAL THERAPY & SPORTS MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-648-0335
Mailing Address - Street 1:2703 N BRISTOL STREET
Mailing Address - Street 2:SUITE H 1
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1472
Mailing Address - Country:US
Mailing Address - Phone:714-664-0411
Mailing Address - Fax:714-664-0402
Practice Address - Street 1:2703 N BRISTOL STREET
Practice Address - Street 2:SUITE H 1
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-1472
Practice Address - Country:US
Practice Address - Phone:714-664-0411
Practice Address - Fax:714-664-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1888252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty