Provider Demographics
NPI:1902190093
Name:BRUNSWICK PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BRUNSWICK PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-834-6898
Mailing Address - Street 1:70 SOUDER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-1245
Mailing Address - Country:US
Mailing Address - Phone:301-834-6898
Mailing Address - Fax:301-834-6595
Practice Address - Street 1:70 SOUDER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21716-1245
Practice Address - Country:US
Practice Address - Phone:301-834-6898
Practice Address - Fax:301-834-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412893100Medicaid
MD412893100Medicaid