Provider Demographics
NPI:1023625712
Name:BRISTOL, KARA (DPT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5011
Mailing Address - Country:US
Mailing Address - Phone:716-648-5211
Mailing Address - Fax:716-649-0075
Practice Address - Street 1:230 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5011
Practice Address - Country:US
Practice Address - Phone:716-648-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06313006Medicaid