Provider Demographics
NPI:1013157874
Name:BRUNSWICK PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:BRUNSWICK PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:ST.GERMAIN
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:518-788-4567
Mailing Address - Street 1:4164 NY2
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-788-4567
Mailing Address - Fax:518-272-3911
Practice Address - Street 1:4164 NY2
Practice Address - Street 2:
Practice Address - City:CROPSEYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12052
Practice Address - Country:US
Practice Address - Phone:518-788-4567
Practice Address - Fax:518-272-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy