NPIMap

Organization Active NPI

Bay State Physical Therapy of Randolph Inc

Doing business as Bay State Physical Therapy

  • Physical Therapist
  • Brockton, MA
National Provider Identifier
1740390459
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BAY STATE PHYSICAL THERAPY OF RANDOLPH INC
Doing business as
Bay State Physical Therapy
Practice address
362 Belmont St
Brockton, MA 02301-4950
Phone
(508) 584-7711
Fax
(508) 584-7744
NPI assigned
Aug 30, 2006
Last updated
Jan 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steven Windwer, DC/PT
Title
Ceo
Phone
(781) 961-3370

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X
Physical Therapist 225100000X MA Primary
Occupational Therapist 225X00000X MA

Addresses

Primary practice location

362 Belmont St
Brockton, MA 02301-4950

Mailing address

703 Granite St Ste 300
Braintree, MA 02184-5350
Phone (781) 961-3370

Other identifiers 1

IdentifierTypeStateIssuer
9705601MedicaidMA

Other names 2

  • Bay State Physical Therapy Doing business as
  • BAY STATE PHYSICAL THERAPY OF RANDOLPH PC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191112001187 MA Part B Supplier - Clinic/Group Practice 6305744251 Receives reassigned benefits from 654 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

703 Granite St
Fl 3
Braintree, MA 02184

67 Parkhurst Rd
Ste 3
Chelmsford, MA 01824
Phone (978) 935-4055

67 Mechanic St
Foxboro, MA 02035
Phone (508) 203-9350

87 Pleasant Valley St
Fl 2
Methuen, MA 01844
Phone (978) 965-6002

375 Faunce Corner Rd
Ste C
North Dartmouth, MA 02747
Phone (774) 425-7906

118 Long Pond Rd
Ste 205
Plymouth, MA 02360
Phone (508) 591-8352

281 Main St
Reading, MA 01867
Phone (781) 205-2130

4 Valente Dr
Westborough, MA 01581
Phone (508) 870-1320

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1740390459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 GRANITE ST STE 300",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021845350",
            "telephone_number": "781-961-3370",
            "fax_number": "781-961-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 BELMONT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023014950",
            "telephone_number": "508-584-7711",
            "fax_number": "508-584-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY STATE PHYSICAL THERAPY OF RANDOLPH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "WINDWER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "781-961-3370",
        "authorized_official_credential": "DC/PT"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9705601",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay State Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BAY STATE PHYSICAL THERAPY OF RANDOLPH PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "BAY STATE PHYSICAL THERAPY OF RANDOLPH PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.