Provider Demographics
NPI:1598560807
Name:BRISTOL, NICOLE (PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEADE DR
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8909
Mailing Address - Country:US
Mailing Address - Phone:908-752-9394
Mailing Address - Fax:
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-337-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO29348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist