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General NPI Number Information
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NPI Number | 1396893590
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CENTER OF BRISTOL, LLC
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Dates
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Enumeration Date | 01/07/2007
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 72 PINE ST
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City | BRISTOL
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State | CT
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Zip | 06010-6960
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Country | US
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Telephone | 860-585-5800
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Fax | 860-585-5840
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Provider Business Mailing Address
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Address Line | PO BOX 632665
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City | CINCINNATI
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State | OH
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Zip | 45263-2665
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Country | US
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Telephone | 702-818-5000
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Fax | 702-818-5001
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | ERIC ELDON DOUGLASS
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Credential | PT
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Telephone | 941-870-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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