NPIMap

Organization Active NPI

Brunswick Physical Therapy LLC

  • Physical Therapist
  • Brunswick, MD
National Provider Identifier
1902190093
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
18229 Issued in MD
Legal business name
BRUNSWICK PHYSICAL THERAPY LLC
Practice address
70 Souder Rd
Brunswick, MD 21716-1245
Phone
(301) 834-6898
Fax
(301) 834-6595
NPI assigned
Jun 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

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

Authorized official

Name
Mr. William Harry Gilbert Jr., MPTNPI 1316942626
Title
President/Owner
Phone
(301) 834-6898

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 18229 MD Primary

Addresses

Primary practice location

70 Souder Rd
Brunswick, MD 21716-1245

Mailing address

70 Souder Rd
Brunswick, MD 21716-1245
Phone (301) 834-6898

Other identifiers 1

IdentifierTypeStateIssuer
412893100MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110622000067 MD Part B Supplier - Clinic/Group Practice 9830377837 Receives reassigned benefits from 1 practitioner
Practice locations: Brunswick, MD

National Provider Directory

National Provider Directory

Locations

70 Souder Rd
Brunswick, MD 21716
Phone (301) 834-6898

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1902190093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 SOUDER RD",
            "city": "BRUNSWICK",
            "state": "MD",
            "postal_code": "217161245",
            "telephone_number": "301-834-6898",
            "fax_number": "301-834-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 SOUDER RD",
            "city": "BRUNSWICK",
            "state": "MD",
            "postal_code": "217161245",
            "telephone_number": "301-834-6898",
            "fax_number": "301-834-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUNSWICK PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-06",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "HARRY",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "301-834-6898",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "18229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "412893100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; 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.