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Individual
TERESA BRISTOL
Active
Individual
TERESA BRISTOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, CERT. DN, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT007043
GA
2251P0200X
Pediatric Physical Therapist
PT007043
GA
2251S0007X
Sports Physical Therapist
PT007043
GA
2251X0800X
Orthopedic Physical Therapist
PT007043
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003190988A
—
GA
01
—
05207111
AMERIGROUP
GA
01
—
105338140-001
TRICARE SOUTH
GA
01
—
4620664
CIGNA
—
Enumeration date
01/26/2006
Last updated
09/20/2019
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