Provider Demographics
NPI:1568567659
Name:GREATER BRUNSWICK PHYSICAL THERAPY P.A.
Entity Type:Organization
Organization Name:GREATER BRUNSWICK PHYSICAL THERAPY P.A.
Other - Org Name:LEWISTON-AUBURN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDWER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT/DC
Authorized Official - Phone:781-961-3370
Mailing Address - Street 1:703 GRANITE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5350
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:11 BOWDOIN MILL IS STE 260
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1274
Practice Address - Country:US
Practice Address - Phone:207-729-1164
Practice Address - Fax:207-725-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1044249OtherAETNA
ME122120000Medicaid
MPA006OtherHARVARD PILGRIM
6722621OtherCIGNA
1044249OtherAETNA