Healthcare Provider Details

I. General information

NPI: 1215890181
Provider Name (Legal Business Name): BRUNSWICK PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CAMPUS DR NW STE 204
SUPPLY NC
28462-4094
US

IV. Provider business mailing address

121 ALHAMBRA PLZ
CORAL GABLES FL
33134-4540
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-5861
  • Fax: 910-755-5865
Mailing address:
  • Phone: 502-609-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC DEYOUNG
Title or Position: CEO
Credential:
Phone: 502-609-4872