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General NPI Number Information
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NPI Number | 1215890181
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Entity Type | Organization
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Legal Business Name | BRUNSWICK PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 20 MEDICAL CAMPUS DR NW STE 204
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City | SUPPLY
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State | NC
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Zip | 28462-4094
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Country | US
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Telephone | 910-755-5861
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Fax | 910-755-5865
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Provider Business Mailing Address
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Address Line | 121 ALHAMBRA PLZ
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City | CORAL GABLES
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State | FL
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Zip | 33134-4540
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Country | US
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Telephone | 502-609-4872
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERIC DEYOUNG
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Credential |
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Telephone | 502-609-4872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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