Healthcare Provider Details

I. General information

NPI: 1396893590
Provider Name (Legal Business Name): PHYSICAL THERAPY CENTER OF BRISTOL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2007
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 PINE ST
BRISTOL CT
06010-6960
US

IV. Provider business mailing address

PO BOX 632665
CINCINNATI OH
45263-2665
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-5800
  • Fax: 860-585-5840
Mailing address:
  • Phone: 702-818-5000
  • Fax: 702-818-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIC ELDON DOUGLASS
Title or Position: CHIEF CLINICAL OFFICER
Credential: PT
Phone: 941-870-4401