Provider Demographics
NPI:1598880395
Name:GREYLOCK PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:GREYLOCK PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUMGART
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:413-442-7007
Mailing Address - Street 1:P.O. BOX 1583
Mailing Address - Street 2:31 WILLIAMSTOWN RD
Mailing Address - City:LANESBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01237-9603
Mailing Address - Country:US
Mailing Address - Phone:413-442-7007
Mailing Address - Fax:413-442-7011
Practice Address - Street 1:31 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:LANESBORO
Practice Address - State:MA
Practice Address - Zip Code:01237-9603
Practice Address - Country:US
Practice Address - Phone:413-442-7007
Practice Address - Fax:413-442-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-03-29
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
000000038655OtherBMC HEALTHNET PLAN
40193OtherHEALTH NEW ENGLAND
637747OtherTUFTS HEALTH PLAN
MAY61482OtherBCBS PROVIDER NUMBER
MA974781Medicaid
6831785OtherCIGNA
9340087OtherAETNA
40193OtherHEALTH NEW ENGLAND