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General NPI Number Information
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NPI Number | 1639595176
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Entity Type | Individual
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Provider Name | LAURA BRISTOL DPT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 1 MARKET PL SUITE 27
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-2942
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Country | US
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Telephone | 802-658-6092
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Fax | 805-863-9565
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Provider Business Mailing Address
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Address Line | 3000 WILLISTON RD STE 3
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6083
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Country | US
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Telephone | 802-324-0588
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Fax | 802-863-9565
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 040.0098735
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License Number State | VT
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