Individual
DR. LEVI RAY BRISTOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2612 SUNNINGDALE PL W, LA GRANGE, KY 40031-8948
(502) 759-2879
Mailing address
3934 CHENOWET SQ, LOUISVILLE, KY 40207
(502) 759-2879
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005609
KY
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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