Healthcare Provider Details

I. General information

NPI: 1164474334
Provider Name (Legal Business Name): BAY STATE PHYSICAL THERAPY OF RANDOLPH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 GRANITE ST STE 300
BRAINTREE MA
02184-5350
US

IV. Provider business mailing address

703 GRANITE ST STE 300
BRAINTREE MA
02184-5350
US

V. Phone/Fax

Practice location:
  • Phone: 781-961-3370
  • Fax: 781-961-1291
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-961-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WINDWER
Title or Position: OWNER
Credential: DC
Phone: 781-961-3370