Provider Demographics
NPI:1053381400
Name:BRISTOL, TERESA (PT, CERT DN, DPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:PT, CERT DN, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W PEACHTREE ST NW
Mailing Address - Street 2:UNIT 1909
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3536
Mailing Address - Country:US
Mailing Address - Phone:470-733-2135
Mailing Address - Fax:855-703-9473
Practice Address - Street 1:1100 PEACHTREE ST NW NE
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:470-733-2135
Practice Address - Fax:855-703-9473
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0070432251P0200X, 2251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003190988AMedicaid
4620664OtherCIGNA
GA05207111OtherAMERIGROUP
GA105338140-001OtherTRICARE SOUTH